Search

Introduction: With advances in the treatment of Pediatric Hematology-Oncology (PHO) patients, the survival of patients are increasing day by day. However, Healthcare-Associated Infections (HAI) is still a significant cause of mortality and morbidity in this group of patients. This study aimed to evaluate the rates of HAI in patients who were hospitalized in Uludag University Medical Faculty PHO Clinic during the 4-year study period. Materials and Methods: HAI was diagnosed according to the CDC (Center for Disease Control and Prevention) 2008 criteria. We recorded the number of patients admitted, the number of patients with HAI, the total number of HAI episodes, and the length of stay in hospital. We calculated HAI rate and HAI density (per 1000 patient-days). Results: During the four years, 3069 hospitalizations were recorded in 607 PHO patients (5.05 admissions per patient). 38.6% of the patients were female, and 61.4% male. The mean age was 100.8 ± 63.6 months. The mean duration of hospitalization was 14 ± 17.16 days. A total of 232 HAI episodes were recorded in 141 hospitalizations. HAI rate was 7.5%, and HAI density was 5.36/1000 patient-days. Conclusion: The HAI rates in our PHO unit were comparable to those of developed countries and lower than those of developing countries and prior results from our country.

Objective: Parents’ lack of knowledge about fever causes fear and incorrect practices. This study aims to investigate the fever knowledge level, concerns, and practices of parents of preschool children. Materials and Methods: In this descriptive, cross-sectional study, conducted between July 2021 and July 2022, a survey was conducted among parents of children aged 6 months to 5 years who did not have a history of febrile seizure and/or chronic disease, either in themselves or their siblings. Results: A total of 386 parents, with a mean age of 33.6 ± 6.38 years and a mean number of children of 1.85 ± 0.9, participated in the study. Approximately one-third of parents started giving antipyretics to their child before the body temperature reached 38°C (32.4%) and/or used them alternately (34.5%). Moreover, approximately two-thirds (67.1%) tended to seek medical help within the first 12 hours. Parents who could not define fever correctly (66.6%) were more likely to start giving antipyretics before the child’s body temperature reached 38°C [odds ratio (OR) 2.83 (1.70-4.71), P < .001] and seek medical help within the first 12 hours [OR 1.81 (1.16-2.82), P = .008]. As the number of children or length of parenting increased, parents started giving antipyretics before the body temperature reached 38°C [OR 1.61 (1.26-2.06), P < .001; OR 1.04 (1.01-1.08), P = .048] and used them alternately [OR 1.07 (1.03-1.11), P = .001; OR 1.28 (1.02-1.62), P = .031]. Conclusion: This study demonstrates that a substantial proportion of parents still cannot define fever correctly, and inappropriate antipyretic use is more prevalent among experienced parents with multiple children and/or longer lengths of parenting.

To fight against the pandemic, which has become the most significant public health problem of modern times, the isolation of patients and early detection of the coronavirus disease-2019 (COVID-19) disease are crucial. This study aimed to show the diagnostic predictor of hemogram parameters and the rates obtained from these parameters in differentiating COVID-19 from other respiratory tract diseases. Data of patients aged between 1 month and 18 years who were admitted to the 3rd and 2nd level pediatric emergency with the pre-diagnosis of “COVID-19-like disease” between 12 January 2022 and July 12, 2022, which is one month after the Omicron (Nu) variant was accepted as an established variant in Türkiye, were retrospectively reviewed. A total of 724 children with pre-diagnosis of COVID-19-like disease whose complete blood count and severe acute respiratory syndrome-coronavirus-2 (SARS‑CoV‑2) polymerase chain reaction (PCR) test from oropharynx/nasopharyngeal swab samples were included in the study. Two hundred children were positive for SARS-CoV-2 PCR (27.6%). Total leukocytes, neutrophils, lymphocytes, monocytes, eosinophils, platelets, platelet distribution width, platelet crit counts, and neutrophil/lymphocyte ratio were lower, and hemoglobin values were higher in the COVID-19 group than in the other group. These differences were statistically significant (p

BackgroundGut microbiota studies in the field of endocrinology metabolism have attracted increasing attention in recent years. To comprehensively assess the evolving landscape of this research field, we conducted a thorough bibliometric analysis of gut microbiota studies in endocrinology metabolism indexed in the Web of Science database.MethodsWe collected and analyzed 3,339 original research articles and reviews published from 1972 to 2023. Using various bibliometric indicators, we investigated publication trends, country contributions, international collaborations, prolific authors, top journals, and influential articles.ResultsOur analysis revealed a significant upsurge in publications after 2010, indicating a growing scientific interest in microbiota and endocrinology metabolism. Keyword and thematic analyses have identified gut microbiota, obesity, diabetes, and inflammation as core research themes. Additionally, the roles of probiotics and prebiotics are increasingly researched for their therapeutic effects in shaping the microbiota.ConclusionThis study reveals that research in endocrinology metabolism is increasingly decoding the connection between gut microbiota and diseases. There’s also a growing focus on microbiota manipulation, which points to a shift towards personalized medicine. Future research should focus on integrating these findings into clinical practice, moving from lab-based studies to real-world patient care.

The aim of this study was to evaluate the effect of Coronavirus disease-2019 (COVID-19) quarantines on children hospitalized for odontogenic cervicofacial infection. The data of patients aged 1 month-18 years, who were followed up with the diagnosis of odontogenic cervicofacial infection in Çanakkale Onsekiz Mart University Hospital between January 2019 and June 2021 was examined, retrospectively. Thirteen patients with a mean age of 8.5±3.8, 7 of whom were male were included in the study. Three of the patients were diagnosed in the pre-COVID-19 period and 10 of them were diagnosed in the second year of COVID-19. Five patients had a known history of dental caries. On physical examination, it was determined that all patients had dental caries in the area corresponding to the infection site. Four patients required abscess drainage, all of whom were presenting in the second year of COVID-19, we isolated Eikenella corrodens, Streptococcus anginosus and Streptococcus intermedius microorganisms in 3 patients. The mean duration of hospitalization was 5.3±3 days. In conclusion, COVID-19 quarantine causes an increase in odontogenic cervicofacial infection requiring intravenous antibiotics and abscess drainage.

Copyright of Motricidade is the property of Silabas Didaticas LDA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction:Inter-hospital transport is an important process of pediatric emergency and pediatric intensive care; the patient is transferred to another center with the emergency medical services. Inter-hospital transport can be life-saving for pediatric patients, but the process can logistically be difficult and risky. The actions required to prevent unwanted events during transport depend mostly on the accurate and reliable data obtained. We think that research on the transport of pediatric patients is limited in our country. Our study investigated the characteristics of pediatric patients transferred to our unit by ambulance and the problems during transport.Methods:One hundred and eighty-three patients under the age of 18 who were referred to the pediatric emergency service between June 2017 and June 2019, whose data were regularly recorded, were included in our study. Data of patients who were sent to the external center for consultation via 112 were excluded. The list of the transferred patients was obtained from 112 command centers in our city and the patient records were analyzed retrospectively with the hospital information management system.Results:Fifty-nine percent of the 183 patients included in our study were male. The mean age of the patients was 62.2±39.1 months. Fourty-two percent of the patients were between 1 month and 3 years old. We found that the most frequent transports are in the spring with 42.6% and 50.9% of the transports took place between 16.00-00.00 hours. We found that the most common transported patients were pneumonia with 28.4% and respiratory distress was the most common adverse event during transport with 7.1%.Conclusion:In the transfer of pediatric patients between hospitals, every step, from the training of staff to the equipment in the ambulance, should be planned in detail. We believe that more studies are needed to examine transport protocols for children’s emergency medical services, the level of education required by the transport team, the state of the medical device used in the transport process, the patient’s pre and posttransport stability, and the safety of the patient during the transport period.

Introduction: The aim of this study is to evaluate the demographic, clinical and laboratory characteristics and treatment results of pediatric patients followed up with the diagnosis of brucellosis in our clinic.Methods: Patients who were followed up with the diagnosis of brucellosis in Kayseri Training and Research Hospital, Pediatric Infectious Diseases Clinic between October 2016 and December 2018 were retrospectively analyzed.Results: A total of 37 patients, 26 (70.3%) male, were included in the study. The mean age of the patients whose ages ranged from 1 to 17 years was 9.3±4.3 years. Unpasteurized milk and/or dairy products were consumed in 86.5% of the patients and 48.6% had a family history of brucellosis. Joint pain (75.7%) was the most common presenting complaint. In the laboratory evaluation, 8.1% of the patients had leukopenia, 2.7% had thrombocytopenia and 21.4% had ALT elevation. Doxycycline plus rifampicin (43.2%) was the most commonly preferred treatment regimen. Addition of aminoglycoside to initial therapy in hospitalized patients was statistically higher than in outpatients (81.2% vs. 23.8%) (p=0.001). During the follow-up, relapse developed in a total of 4 (10.8%) patients, 3 of whom were outpatients. There was no statistical relationship between the initial treatment regimen and relapse (p=0.418).Conclusion: In conclusion, brucellosis should be kept in mind in terms of differential diagnosis in patients who present with joint pain in our country and who have cytopenia and/or isolated aminotransferase elevation in their investigations.Keywords: Child, Brucellosis, Relapse

Objectives: Septic arthritis (SA) is a serious bacterial infection that must be treated efficiently and timely. The large number of culture-negative cases makes local epidemiological data important. Accordingly, this study aimed to evaluate the etiology, clinical characteristics, and therapeutic approach of SA in children in Turkiye, emphasizing the role of real-time polymerase chain reaction (PCR) techniques in the diagnosis. Methods: In this multi-center, prospective study, children hospitalized due to SA between February 2018 and July 2020 in 23 hospitals in 14 cities in Turkiye were included. Clinical, demographic, laboratory, and radiological findings were assessed, and real-time PCR was performed using synovial fluid samples. Results: Seventy-five children aged between 3 and 204 months diagnosed with acute SA were enrolled. Joint pain was the main complaint at admission, and the most commonly involved joints were the knees in 58 patients (77.4%). The combination of synovial fluid culture and real-time PCR detected causative bacteria in 33 patients (44%). In 14 (18.7%) patients, the etiological agent was demonstrated using only PCR. The most commonly isolated etiologic agent was Staphylococcus aureus, which was detected in 22 (29.3%) patients, while Streptococcus pyogenes was found in 4 (5.3%) patients and Kingella kingae in 3 (4%) patients. Streptococcus pyogenes and Kingella kingae were detected using only PCR. Most patients (81.3%) received combination therapy with multiple agents, and the most commonly used combination was glycopeptides plus third-generation cephalosporin. Conclusions: Staphylococcus aureus is the main pathogen in pediatric SA, and with the use of advanced diagnostic approaches, such as real-time PCR, the chance of diagnosis increases, especially in cases due to Kingella kingae and Streptococcus pyogenes.

Objective: We aimed to adapt the Facial Nerve Grading System 2.0 (FNGS 2.0) to Turkish and to investigate the validity and the reliability of the Turkish version.Methods: The original FNGS 2.0 was translated into Turkish and validated by international standards. Six Turkish physicians, three specialists and three residents, independently rated the videos, two times each, of 40 adult facial palsy patients. Inter-rater and intra-rater reliability were assessed using the intraclass correlation coefficient (ICC) and Cronbach’s alpha coefficient. As another indication of reliability, “generalizability” was also evaluated. For all analyses, a p value of

The golden twin-spot moth (Chrysodeixis chalcites) is one of the most important pests in banana production on the Canary Islands (Spain). The efficacy of different biorational insecticides based on bioenzyme complexes (Intruder®), plant extracts: Rutaceae and Piperaceae (Avenger®), Rutaceae and Lauraceae (BioKnock®), cinnamon, citronella, and Menta (Cinamite®), Alliaceae and Solanacea (Garlitrol-Forte®), citrus (Prevam®), and neem oil (Indasol®) was assessed against C. chalcites. Laboratory assays included: choice (repellent effect), no choice, and contact toxicity on C. chalcites 2nd instar larvae. The highest repellent effect was observed with Prevam® (85.19 ± 1.7%), followed by Garlitrol® (68.44 ± 5.7%) and Intruder® (67.54 ± 4.3%). In no choice assays, Prevam® (0.92 ± 0.4%), Indasol® (0.98 ± 0.33%), and Intruder® (2.7 ± 0.33%) had the lowest leaf consumption. The contact toxicity assays showed the highest mortality with Intruder® both at 1 day and 7 days post-application (20.22 ± 2.98% and 77.77 ± 5.7%, respectively). In the screenhouse trial, the best results for C. chalcites larvae mortality, fruit damage, and fruit classification in quality categories 7 days after application of the bioinsecticide were obtained with Intruder®, Prevam®, and Indasol®. An economic analysis of biorational treatments was also performed. The results of this study provide successful alternatives to chemical pesticides for the control of C. chalcites on banana plants in the Canary Islands.

Alphabaculovirus of Chrysodeixis chalcites (ChchNPV-TF1) has been investigated as a useful bioinsecticide against C. chalcites (Esper) (Lepidoptera: Noctuidae) in banana crops. This study investigated the effects of several substances on the persistence of ChchNPV-TF1 under field conditions in the Canary Islands. Natural photoprotective substances, such as moringa, cacao, green tea, benzopurpurine, charcoal, iron dioxide, benzimidazole, kaolinite, and bentonite, were first evaluated under laboratory conditions using a Crosslinker as UV light source at 200 J/cm2. The photoprotective substances were divided into three groups: low protection (0-8%; kaolinite), intermediate protection (48-62%; green tea, moringa, bentonite and cacao) and high protection (87-100%; charcoal, iron ioxide). Benzopurpurine and benzimidazole did not provide any photoprotective effects. Two of the substances that yielded the best results, 1% cacao and 1% charcoal, were selected for the open-field experiment in a banana plantation. The persistence of ChchNPV-TF1 OBs (occlusion bodies) on leaf surfaces with sunlight exposure was analysed by comparing the initial mortality of 2nd instar C. chalcites larvae with the mortality observed at various intervals postapplication. The mortality rates decreased over time in all treatments and were always higher in the UV-protective substance-treated parcels. The 1% charcoal treatment exhibited the highest protection in both the laboratory and field experiments. No specific interference of UV-protective substances on the maximum photochemical efficiency of banana plants was observed under field conditions.

A 15-year-old female patient, who had no previous history of illness, had the complaint of intermittent cough and chest pain for 2 months. Two days ago, she applied to the hospital with difficulty in breathing added to her complaints. Tomography (CT) was planned due to the presence of pneumonic infiltration in the left lung (Figure 1) in the chest radiography of the patient who was hospitalized in the intensive care unit due to respiratory distress. The patient was referred to us after Covid-19 was considered. On physical examination, there was bilateral diffuse ral in the lung with auscultation and respiratory sounds were decreased in the left lung. Its oksigen saturation was determined as 89% on room air, RR:28/min. Pathologically in laboratory evaluation; Erythrocyte Sedimentation Rate:56 mm/hour, C-reactive protein:8 mg/dl. The patient was admitted to the pandemic service with the pre-diagnosis of Covid-19 infection and Pneumonia. There was a history of smoking 1 pack per day for 2-3 years. The pneumonia treatment of the patient was arranged as Ceftriaxone and Azithromycin. Covid-19 PCR Tests taken resulted as Negative. In thoracic CT imaging, it was evaluated as significant by the radiology in terms of tuberculosis (TB)(Figure 2). The PPD of the patient was evaluated as negative with 3 mm (BCG single scar). There was no known history of tuberculosis contact in the family history. With the diagnosis of "Pulmonary Tuberculosis" with the diagnosis of sputum ARB (++), antituberculosis treatment consisting of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol was initiated due to cavity-widespread pulmonary TB. The patient, whose need for oxygen decreased during follow-up, was discharged on the 10th day of his treatment, with outpatient follow-up planned. In some individuals, tuberculosis bacillus reacts and multiplies, causing the development of post-primary TB. Although the post-primary TB radiological findings may overlap with the findings of primary TB, it has some distinctive findings such as preferring the upper lobes, not following lymphadenopathy, and a tendency to create cavitation (1). Tomography provides important contributions in the detection of parenchymal pathology and lymphadenopathies in patients who are evaluated with the pre-diagnosis of tuberculosis, or in patients with suspected tuberculosis clinically but without radiographic findings (2). In this period when Covid-19 infection is common, tuberculosis should be kept in mind in patients with long-term cough.

Purpose: The purpose of this study was to investigate the healing differences in between four different widely used suture materials in the oral surgery practice, including silk (Perma- Hand; Ethicon, INC., Somerville, NJ, USA), polypropylene (Prolene; Ethicon, INC., Somerville, NJ, USA), coated polyglactin 910 (Ethicon, INC., Somerville, NJ, USA). and polyglecaprone 25 (Ethicon, INC., Somerville, NJ, USA ). Materials and Methods: 20 male rats were randomly allocated into two groups depending on their sacrification days (post-operative 1st and the 7th days). Four longitudinal incision wounds, each 1cm in size, were created on the dorsum of each animal which were then primarily closed with four different types of sutures. Results: The effects of these suture materials on soft tissue healing were compared histopathologically, by means of density of the cells, necrosis, fibrosis, foreign body reaction, the presence of cells of acute and chronic infection. No statistically significant difference was observed between the groups regarding the density of the cells, necrosis, fibrosis, foreign body reaction, and the presence of the cells of acute & chronic infections. Of note, propylene showed slightly less tissue reaction among the other materials. Conclusion: The results of our study showed that there is no only one ideal suture material for surgical practice. The factors related to the patient, the type of the surgery and the quality of the tissue are important to decide an appropriate suture material.

Phyllodes tumor of the breast is a rare fi broepithelial lesion. Between January 1993 and January 2008, 19 patients diagnosed with phyllodes tumor, were retrospectively analyzed in terms of demographic and clinicopathologic features and treatment modalities. The median age was 43 (range, 20-65). For diagnosis, 11 patients underwent excisional biopsy, 4 cases had incisional biopsies, and 4 patients had core biopsies/fi ne needle aspiration cytology. One patient with T4 tumor and lung metastasis was considered inoperable and received chemotherapy alone. Thirteen patients had breast conservative surgery (lumpectomy or reexcision), whereas 5 patients underwent mastectomy. The median tumor size was 7 cm (range, 2-21 cm). The pathologic classifi cation of the tumors was as follows: benign (n=6, 31.5%), borderline (n=6, 31.5%), and malignant (n=7, 37%). Among those with malignant phyllodes, 2 patients received chemotherapy and radiotherapy followed by mastectomy, and three patients with lumpectomy had radiotherapy. Median follow-up time was 36 months (4-108). One patient with malignant phylloides with mastectomy had lung metastases at the 24th month followed by chemotherapy&radiotherapy, and died of metastatic disease 3 months later. Furthermore, another patient with benign phyllodes who underwent lumpectomy with unknown surgical margins was found to have a local recurrence as benign phyllodes at the 37th month. No other recurrences were noted. The 5-year overall survival of patients with borderline&malign phyllodes was 83%. In conclusion, margin negative surgery plays a major role in the management of patients diagnosed with phyllodes tumors. However, the survival benefi t of adjuvant chemotherapy or radiation treatment warrants further investigation.

Background: Therapeutic apheresis (TA) are promising treatment option for neuroimmunological disorders. In paediatrics, the available data is limited, particularly for the use of IA. The aim of this study was to analyse the use of PE and IA in children and adolescents, with emphasis on outcome and neurological course after treatment as well as the safety of the two modalities., Methods: Clinical data from paediatric patients with neuroimmunological disorders treated with TA in two German university children's hospitals between 2015 and 2022 were retrospectively analysed., Results: In total, 39 patients underwent 322 sessions of TA, of which 184 were IA and 138 PE. The most common diagnosis was autoimmune encephalitis in 39 % (n = 15) of the patients. Other indications were central nervous system inflammatory demyelinating disorders in 21 % (n = 8), Guillain-Barré syndrome in 18 % (n = 7), Myelin Oligodendrocyte Glycopeptide-antibody associated syndromes in 8 % (n = 3), Myasthenia gravis in 5 % (n = 2) and other neurological disorders in 10 % (n = 4). Overall, there was an improvement in 76 % of patients (81 % with IA, 70 % with PE; p = 0.41) immediately after treatment and an improvement in 88 % of patients (90 % with IA, 85 % with PE; p = 0.63) one month after treatment. Complications occurred in 13 % of all sessions (13 % with IA and 13 % with PE; p = 1). Most complications were considered as moderate., Conclusion: Both, IA and PE, are effective treatment options in the therapy of neuroimmunological disorders in children and adolescents, with no major differences in terms of efficiency or safety., Competing Interests: Declaration of competing interest None of the authors has any conflicts of interest to declare in association with this manuscript., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder characterised by extremely high concentrations of LDL cholesterol, leading to early-onset atherosclerosis. Lomitapide is an orally administered microsomal triglyceride transfer protein (MTP) inhibitor that effectively lowers LDL cholesterol and is approved for adults with HoFH. We aimed to investigate the efficacy and safety of lomitapide in paediatric patients with HoFH receiving standard-of-care lipid-lowering therapy., Methods: APH-19 is an open-label, single-arm, phase 3 trial performed at 12 study centres in Germany, Israel, Italy, Saudi Arabia, Spain, and Tunisia. A 6-week run-in period was followed by a 24-week efficacy phase and an 80-week safety phase. Patients aged 5-17 years, on stable lipid-lowering therapy, with HoFH diagnosed using the criteria from the 2014 European Atherosclerosis Society Consensus Panel on HoFH were titrated to maximum tolerated doses of oral lomitapide, starting at 2 mg (patients aged 5-15 years) or 5 mg (patients aged 16-17 years). The primary endpoint was the percentage change from baseline to week 24 in LDL cholesterol, which was assessed in patients who had received at least one dose of lomitapide, and who had a baseline and at least one post-baseline measurement. The secondary outcomes were the percentage change from baseline at week 24 in total cholesterol, non-HDL cholesterol, VLDL cholesterol, apolipoprotein B, triglycerides, and lipoprotein(a). Safety was assessed in patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, NCT04681170., Findings: Between Dec 20, 2020, and Oct 16, 2022, 43 patients were included and treated (24 [56%] were female and 19 [44%] were male, and median age was 10·7 years [7·0-14·0]). Mean change from baseline in LDL cholesterol at week 24 was -53·5% (95% CI -61·6 to -45·4, p<0·0001). Mean percentage reductions were observed at week 24 for non-HDL cholesterol (-53·9%, 95% CI -61·7 to -46·1, p<0·0001), total cholesterol (-50·0%, 95% CI -57·6 to -42·4, p<0·0001), VLDL cholesterol (-50·2%, -59·1 to -41·2, p<0·0001), apolipoprotein B (-52·4%, -60·3 to -44·5, p<0·0001), triglycerides was -49·9% (-58·8 to -41·0, p<0·0001), and lipoprotein(a) (-11·3%, -32·9 to 10·3 [in 21 patients with measurements in mg/dL]; -23·6%, -38·2 to -9·0 [in 22 patients with measurements in nmol/L]; p=0·0070 combined). Adverse events were mostly mild, and gastrointestinal and hepatic in nature. Adverse events of special interest were reported for five (12%) patients (gastrointestinal in two patients and hepatic in three). One serious treatment-emergent adverse event was reported (also classed as an adverse event of special interest): an increase in hepatic enzymes, resulting in two dose interruptions, two dose reductions, and a repeated dose escalation., Interpretation: Lomitapide provided a significant, clinically meaningful LDL cholesterol reduction and has the potential to be an efficient, LDL receptor-independent option for paediatric patients with HoFH., Funding: Amryt Pharmaceuticals., Competing Interests: Declaration of interests LM has received fees for lectures or advisory work from Amarin, Amryt Pharmaceuticals, Daiichi-Sankyo, Ferrer, Novartis, Sanofi, Servier, and Viatris. CPS has received lecturing honoraria from Fresenius Medical Care; advisory fees from Baxter, Stada and Iperboreal Pharma; and research funding from Invizius. AZ has received personal speakers fees from AlfaSigma, Amryt Pharmaceuticals, Amarin, Sobi, Sanofi-Aventis, Servier, Amgen, Mylan, Abbott, Novartis, and Fidia; and personal consultancy or advisory board fees from Abbott, Amarin, and Novartis. CT has received honoraria from Novartis, Sanofi, and Danone. HC received consultation fees from Sanofi; lecture fees from Novartis, Sanofi, Medison Pharma, Abbott, Neopharm, and Organon; and research support from Medison Pharma. JLD-D has received honoraria for speaker or researcher activities from Merck Sharp & Dohme, Amgen, and Sanofi. SM-H has received fees for speaker or advisory work from Amarin, Amryt, Daiichi-Sankyo, MSD, Novartis, Sanofi, and Ultragenyx. BM is a consultant for Amryt Pharmaceuticals. TC and SL are employees of Amryt Pharmaceuticals. NK reports financial support and honoraria from Amryt Pharmaceuticals. All other authors declare no competing interests., (Copyright © 2024 Published by Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Homozygous familial hypercholesterolaemia is a life-threatening genetic condition, which causes extremely elevated LDL-C levels and atherosclerotic cardiovascular disease very early in life. It is vital to start effective lipid-lowering treatment from diagnosis onwards. Even with dietary and current multimodal pharmaceutical lipid-lowering therapies, LDL-C treatment goals cannot be achieved in many children. Lipoprotein apheresis is an extracorporeal lipid-lowering treatment, which is used for decades, lowering serum LDL-C levels by more than 70% directly after the treatment. Data on the use of lipoprotein apheresis in children with homozygous familial hypercholesterolaemia mainly consists of case-reports and case-series, precluding strong evidence-based guidelines. We present a consensus statement on lipoprotein apheresis in children based on the current available evidence and opinions from experts in lipoprotein apheresis from over the world. It comprises practical statements regarding the indication, methods, treatment goals and follow-up of lipoprotein apheresis in children with homozygous familial hypercholesterolaemia and on the role of lipoprotein(a) and liver transplantation., Competing Interests: Declaration of competing interest SDdF received grants from the National Institutes of Health/National Heart, Lung, and Blood Institute of the National Institutes of Health, the Family Heart Foundation and holds a patent for UpToDate, with royalties paid. AG received grants and personal fees from Amgen, Sanofi and Regeneron, Mylan Viatris, MSD, Akcea Therapeutics, Amryt, Servier, Novartis and Ultragenyx. SGP received study funding from Amgen. JH received a research grant from the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K23HL145109. DI received advisory honoraria from Amryt, and honoraria for lectures from Sanofi, Sobi and Novartis. CPS received advisory honoraria from Baxter, Iperboreal and Stadapharma, lecturing honoraria from Fresenius and research funding from Baxter. MK received honoraria from Abbott, Abdi Ibrahim, Amryt, LIB Therapeutics, NovoNordisk, and TR-pharma; research funding from Amryt Pharma, and participated in clinical trials with Amgen, Ionis, LIB Therapeutics, Novo Nordisk, Sanofi. RK, as head of the Apheresis Research GmbH, Cologne, Germany received financial grants for scientific research projects, honoraria for consulting and presentation of lectures including travel expenses from the companies Diamed, Cologne, Germany, and Asahi Kasei Medical, Tokyo, Japan. GK has given talks, attended conferences, received consultancy fees and participated in trials sponsored by Amgen, Novartis, Sanofi, Servier, Amryt. AW received research grants from Amgen, Regeneron, Novartis, Silence Therapeutics, Esperion, and Ultragenyx and advisory honoraria from Amryt, and Novartis. KA, EJD, LMdB, JWG, LCH, GDK, JO, RNP, MDR, CS and CT have nothing to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Homozygous familial hypercholesterolaemia is a life-threatening genetic condition, which causes extremely elevated LDL-C levels and atherosclerotic cardiovascular disease very early in life. It is vital to start effective lipid-lowering treatment from diagnosis onwards. Even with dietary and current multimodal pharmaceutical lipid-lowering therapies, LDL-C treatment goals cannot be achieved in many children. Lipoprotein apheresis is an extracorporeal lipid-lowering treatment, which is well established since three decades, lowering serum LDL-C levels by more than 70% per session. Data on the use of lipoprotein apheresis in children with homozygous familial hypercholesterolaemia mainly consists of case-reports and case-series, precluding strong evidence-based guidelines. We present a consensus statement on lipoprotein apheresis in children based on the current available evidence and opinions from experts in lipoprotein apheresis from over the world. It comprises practical statements regarding the indication, methods, treatment targets and follow-up of lipoprotein apheresis in children with homozygous familial hypercholesterolaemia and on the role of lipoprotein(a) and liver transplantation.

Background: The unphysiological composition of peritoneal dialysis (PD) fluids induces progressive peritoneal fibrosis, hypervascularization and vasculopathy. Information on these alterations after kidney transplantation (KTx) is scant., Methods: Parietal peritoneal tissues were obtained from 81 pediatric patients with chronic kidney disease stage 5 (CKD5), 72 children on PD with low glucose degradation product (GDP) PD fluids, and from 20 children 4-8 weeks after KTx and preceding low-GDP PD. Tissues were analyzed by digital histomorphometry and quantitative immunohistochemistry., Results: While chronic PD was associated with peritoneal hypervascularization, after KTx vascularization was comparable to CKD5 level. Submesothelial CD45 counts were 40% lower compared with PD, and in multivariable analyses independently associated with microvessel density. In contrast, peritoneal mesothelial denudation, submesothelial thickness and fibrin abundance, number of activated, submesothelial fibroblasts and of mesothelial-mesenchymal transitioned cells were similar after KTx. Diffuse peritoneal podoplanin positivity was present in 40% of the transplanted patients. In subgroups matched for age, PD vintage, dialytic glucose exposure and peritonitis incidence, submesothelial hypoxia-inducible factor 1-alpha abundance and angiopoietin 1/2 ratio were lower after KTx, reflecting vessel maturation, while arteriolar and microvessel p16 and cleaved Casp3 were higher. Submesothelial mast cell count and interleukin-6 were lower, whereas transforming growth factor-beta induced pSMAD2/3 was similar as compared with children on PD., Conclusions: Peritoneal membrane damage induced with chronic administration of low-GDP PD fluids was less severe after KTx. While peritoneal microvessel density, primarily defining PD transport and ultrafiltration capacity, was normal after KTx and peritoneal inflammation less pronounced, diffuse podoplanin positivity and profibrotic activity were prevalent., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)

In recent years, migration and the social changes associated with it have increasingly become the focus of scientific interest. The diversity of cultures in hospitals poses a major challenge. Medical teams are often confronted with language barriers and different concepts of illness, health, and healing. The field is wide, and in addition to foreign language skills, primarily human skills such as self-awareness, communication, and empathy are demanded. Religion also plays a role in medical care for patients with a foreign cultural background. This work is intended to provide an overview of the scientifically based necessary skills in dealing with this patient clientele and to give an insight into the personal experiences of the authors. After many years of dealing with intercultural care of patients, this experience has shown one thing above all: Sometimes, it is beyond language and just needs humanity., (© 2022. The Author(s).)