Loftbach4962

An abdominal aortic aneurysm is rarely seen in children. We report the case of a 15-year-old girl who presented with lower back pain in a subfebrile setting with moderate biological inflammatory syndrome. Imaging assessment, including a spinal magnetic resonance imaging, had shown no evidence of spondylodiscitis or other spinal or renal pathology. Ten days later, she presented in hemorrhagic shock and was found to have a ruptured infected aneurysm of the abdominal aorta.

This case reminds us to include an aneurysm in the differential diagnosis of lower back pain, even in children.

This case reminds us to include an aneurysm in the differential diagnosis of lower back pain, even in children.

A 42-year-old woman presented with a severe neck pain and torticollis due to uncertain etiology. Because her radiographs and computed tomography revealed atlantoaxial rotatory fixation (AARF) that is an extremely rare condition in the adult population, a nonsurgical treatment was initially applied. Because 3 weeks of indirect traction failed, closed reduction was performed under general anesthesia at 2 months after onset, and her symptoms markedly improved without any complications and recurrence.

Closed reduction under general anesthesia for nontraumatic AARF in adult patients might be an effective treatment option, even for chronic cases or intractable cases by traction treatment.

Closed reduction under general anesthesia for nontraumatic AARF in adult patients might be an effective treatment option, even for chronic cases or intractable cases by traction treatment.

We present the case of an infant with an amputation from amniotic band syndrome and no other complications. During the seventh week of life, the infant developed severe pain in the affected limb that was ultimately found to be indicative of osteomyelitis.

The infant displayed minimal systemic response, and cultures that grew methicillin-sensitive Staphylococcus aureus were needed to confirm the diagnosis. Surgical debridement, stump revision, and oral antibiotic therapy provided definitive treatment for our patient. The reader is encouraged to consider the possibility of osteomyelitis in similar circumstances.

The infant displayed minimal systemic response, and cultures that grew methicillin-sensitive Staphylococcus aureus were needed to confirm the diagnosis. Surgical debridement, stump revision, and oral antibiotic therapy provided definitive treatment for our patient. The reader is encouraged to consider the possibility of osteomyelitis in similar circumstances.

Three patients (age, 15-34 years) who had a history of chronic traumatic anteroinferior glenohumeral instability (2-10 dislocations) and preoperatively documented Bankart and Hill-Sachs lesions underwent all-arthroscopic trans-subscapular transposition of the long head of the biceps that was fixed on the anteroinferior glenoid using a novel double double-pulley all-suture anchor method that has not been reported previously.

Excellent 12-month clinical and imaging outcomes, with substantial improvements in the Western Ontario Shoulder Index and the Rowe score in the first consecutive patients who underwent this original technical variant of dynamic anterior stabilization and the surgical pearls and pitfalls are described in detail.

Excellent 12-month clinical and imaging outcomes, with substantial improvements in the Western Ontario Shoulder Index and the Rowe score in the first consecutive patients who underwent this original technical variant of dynamic anterior stabilization and the surgical pearls and pitfalls are described in detail.

Transcatheter aortic valve implantation (TAVI) is being increasingly used in patients with longer life expectancy. Data on long‑term outcomes are still limited.

The aim of the study was to assess the clinical outcomes of patients treated with TAVI and identify baseline and procedure‑related factors influencing long‑term survival.

Symptomatic patients with critical aortic stenosis who were inoperable or had high surgical risk were qualified for TAVI. Between August 2012 and December 2017, 248 consecutive patients treated with self ‑expanding Medtronic valve implantation at American Heart of Poland in Bielsko‑Biała were prospectively enrolled. Patients were followed for 30 days after the procedure and subsequently annually. All events were classified according to the Valve Academic Research Consortium‑2 (VARC‑2) criteria and assessed. Survival was compared between the subgroups defined by the EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) and with matched representatives from the l population.

TAVI with a self‑expanding Medtronic valve implantation according to a consistent protocol was associated with favorable outcomes. Patients with lower EuroSCORE II scores had the same prognosis as the actuarial survival of the general population.

Heart rate control in atrial fibrillation (AF) is typically assessed by 24‑hour electrocardiography (ECG). There are scarce data on the use of 24‑hour ECG parameters to predict mortality in patients with AF.

We aimed to identify 24‑hour ECG parameters that predict mortality in patients with AF.

We enrolled 280 ambulatory patients (mean [SD] age, 72 [8.7] years; 57.9% men) with permanent or persistent AF. Data on mortality and pacemaker or defibrillator implantation during follow‑up were collected. Predictors of mortality were assessed using the Cox proportional hazards model and C statistic.

Compared with survivors, 78 patients (28%) who died were older, more often had comorbidities, left bundle branch block (LBBB), reduced left ventricular ejection fraction, lower maximum heart rate, higher number of ventricular extrasystoles, and the longest R‑R interval below 2 seconds. Univariate analysis showed higher mortality in patients with the longest R‑R intervals below 2 seconds compared with those with R‑R intervals of 2 seconds or longer (P <0.001). Independent mortality predictors in the regression model included older age, renal failure, history of coronary intervention, chronic obstructive pulmonary disease, LBBB, and a high number (≥770) or absence of R‑R intervals of at least 2 seconds. The area under the curve for mortality prediction increased after including ECG parameters (0.748; 95% CI, 0.686-0.81; vs 0.688; 95% CI, 0.618-0.758; P = 0.02).

A high number of R‑R intervals longer than 2 seconds or their absence on 24‑hour ECG may predict mortality in patients with AF.

A high number of R‑R intervals longer than 2 seconds or their absence on 24‑hour ECG may predict mortality in patients with AF.Persistent foramen ovale (PFO) is a congenital heart disease which represents 80% of atrial septal defects. It is a remnant of fetal circulation that functions in postnatal conditions as a transient interatrial right‑to‑‑left shunt of variable magnitude. Persistent foramen ovale may be implicated in the pathogenesis of several medical conditions, such as cryptogenic stroke, cryptogenic left circulation thromboembolism, migraine syndromes, and decompression sickness. The most frequent indication for PFO closure remains PFO‑associated left circulation thromboembolism. In select patients, PFO closure reduces stroke recurrence in comparison with medical therapy after more than 3 years of follow‑up on average, especially in patients with a high risk of recurrence. While in PFO‑associated left circulation embolism, there is now conclusive evidence on the growing benefit of PFO closure in long‑term follow‑up, in many other clinical conditions, the degree of certainty of the results is deceiving. In this paper, we will review the benefits and risks that one can expect in the long term after percutaneous PFO closure in various clinical scenarios in order to facilitate therapeutic decision making.

Transcatheter patent ductus arteriosus (PDA) closure has become the first‑choice method of treatment in the majority of patients. However, device selection poses a challenge.

This study aimed to analyze periprocedural and 1‑year outcomes of PDA transcatheter closure performed with different devices throughout a 25‑year time period in a single center.

All 1036 patients who underwent transcatheter PDA closure between 1993 and 2020 were included in retrospective analysis. Various devices were used the Rashkind device (RD; n = 25), coils (n = 469), nitinol duct occluders type I (DO I; n = 300), type II (n = 32), type II additional sizes (ADO II AS; n = 209), as well as off‑label devices vascular plugs and atrial septal and muscular ventricular septal defect occluders (n = 17). Data on 24‑hour and 1‑year follow‑up were available for 100% and 78.9% of the study patients, respectively.

The procedure was successful in 98.6% of the study patients, with a major complication rate of 0.2%. Complete PDA closure after a year was observed in 81.8% of the patients treated with RD, 93.7% of those with coils, and 100% of those with duct occluders. There were no differences between Amplatzer DO I (n = 159) and its DO I copies manufactured in China (n = 141) with regard to success, efficacy, and complication rates. Recently, ADO II AS has replaced coils and become the preferred device to close small‑to‑moderate PDA.

Transcatheter PDA closure with all types of nitinol duct occluders is safe and effective, with no residual shunting at 1‑year follow‑up. Due to higher efficacy, ADO II AS has replaced coils in the treatment of smaller PDA.

Transcatheter PDA closure with all types of nitinol duct occluders is safe and effective, with no residual shunting at 1‑year follow‑up. Due to higher efficacy, ADO II AS has replaced coils in the treatment of smaller PDA.

The incidence of colorectal cancer in North America is rising among patients younger than 50 years. Available data are conflicting regarding presentation and outcomes in this population. This review aimed to synthesize literature regarding young patients with colorectal cancer with respect to patient demographics, disease extent and survival, compared with patients older than 50 years.

We searched Medline, Embase, the Cochrane Central Register of Controlled Trials and PubMed for articles published between 1990 and the time of search. Articles comparing North American patients with colorectal cancer younger and older than 50 years were eligible for inclusion. We used a random-effects model to pool odds ratios.

Eight retrospective studies were eligible for inclusion (n = 790 959). Mean age was 42.6 years (standard deviation [SD] 5.07) in the younger group, and 69.1 years (SD 9.25) in the older group. Young patients were more likely to present with regional (odds ratio [OR] 1.27, 95% confidence interval [Cy different between these groups, younger patients have improved survival when controlling for cancer stage.

Obesity is an important comorbidity affecting outcomes after total joint arthroplasty. Consequently, surgeons may delay care of obese patients to first address obesity through different care pathways. The effect of obesity on patient wait times for total joint arthroplasty has not been explored. The purpose of this study was to evaluate the effect of obesity on access to total hip (THA) and knee (TKA) arthroplasty.

The study data set was constructed from the Nova Scotia Health Authority's Horizon Patient Folder system and the Patient Access Registry Nova Scotia. Wait time was measured as days between the decision to treat and date of surgery. Body mass index (BMI) was calculated from a preoperative assessment, and patients were grouped into BMI categories. Multivariate log-linear regression was used to test for statistical differences, controlling for confounding factors.

We observed longer wait times for TKA with increasing BMI weight class. Patients with BMIs greater than 50 had 34% longer waits than reference weight patients. However, THA recipients showed no statistical difference in wait times across weight categories. Furthermore, there was variability among surgeons in the wait times experienced by patients.

The finding of longer wait times for TKAs, but not THAs, among patients who were obese was unexpected. This shows the variable wait times for THA and TKA that patients who are obese can experience with different surgeons. It is important to understand the variability in wait times so that efforts to standardize the patient experience can be accomplished.

The finding of longer wait times for TKAs, but not THAs, among patients who were obese was unexpected. This shows the variable wait times for THA and TKA that patients who are obese can experience with different surgeons. It is important to understand the variability in wait times so that efforts to standardize the patient experience can be accomplished.Since December 2019, there has been a global explosion of research on COVID-19. In Canada, the six National Collaborating Centres (NCCs) for Public Health form one of the central pillars supporting evidence-informed decision making by gathering, synthesizing and translating emerging findings. Funded by the Public Health Agency of Canada and located across Canada, the six NCCs promote and support the use of scientific research and other knowledges to strengthen public health practice, programs and policies. This paper offers an overview of the NCCs as an example of public health knowledge mobilization in Canada and showcases the NCCs' contribution to the COVID-19 response while reflecting on the numerous challenges encountered.

Canadian distillers and brewers have claimed that between 50% and 80% of the price of alcoholic drinks are government taxes. These claims were made in campaigns to decrease alcohol taxation.

We investigated these claims using publicly available Statistics Canada data and provincial-level product sales data and breakdowns of the prices of typical alcohol beverages in major market sectors.

In all cases, the rate of total sales tax and excise taxation are mostly between 20% and 30% of final retail prices, well below the industry claims.

In all cases, the rate of total sales tax and excise taxation are mostly between 20% and 30% of final retail prices, well below the industry claims.

Physician payment models are known to affect the nature and volume of services provided. Our objective was to study the effects of removing a financial incentive, the fee-for-service premium, on the provision of chronic disease follow-up services by internal medicine, cardiology, nephrology and gastroenterology specialists.

We collected linked administrative health care data for the period 1 April 2013 to 31 March 2017 from databases held at the Institute for Clinical Evaluative Sciences (ICES) in Ontario, Canada. We conducted a time-series analysis before and after the removal of the fee-for-service premium on 1 April 2015. The primary outcome was total monthly visits for chronic disease follow-up services. Secondary outcomes were monthly visits for total follow-up services and new patient consultations. We compared internal medicine, cardiology, nephrology and gastroenterology specialists practising during the study timeframe with respirology, hematology, endocrinology, rheumatology and infectious diseases specialists who remained eligible to claim the premium. We chose this comparison group as these are all subspecialties of internal medicine, providing similar services.

The number of chronic disease follow-up visits decreased significantly after removal of the premium, but there was no decrease in total follow-up visits. There was also a significant downward trend in new patient consultations. No changes were observed in the comparison group.

The decrease in volume of chronic disease follow-up visits can be explained by diagnostic criteria being met less often, rather than an actual reduction in services provided. Potential effects on patient outcomes require further exploration.

The decrease in volume of chronic disease follow-up visits can be explained by diagnostic criteria being met less often, rather than an actual reduction in services provided. Potential effects on patient outcomes require further exploration.

The Canadian Longitudinal Study on Aging (CLSA) is a rich, nationally representative population-based resource that can be used for multiple purposes. Although municipalities may wish to use CLSA data to address local policy needs, how well localized CLSA cohorts reflect municipal populations is unknown. Because Calgary, Alberta, is home to one of 11 CLSA data collection sites, our objective was to explore how well the Calgary CLSA sample represented the general Calgary population on select sociodemographic variables.

Baseline characteristics (i.e. sex, marital status, ethnicity, education, retirement status, income, immigration, internal migration) of CLSA participants who visited the Calgary data collection site between 2011 and 2015 were compared to analogous profiles derived from the 2011 National Household Survey (NHS) and 2016 Census datasets, which spanned the years when data were collected on the CLSA participants.

Calgary CLSA participants were representative of the Calgary population for age, cs of interest.

Positive mental health is an essential part of youth's healthy development. For instance, positive mental health is associated with greater self-reported physical health, closer relationships and fewer conduct problems in youth. As positive mental health promotion is a public health priority, examining its potential determinants is important.

We analyzed data from students in Grades 7-12 (secondary I-V in Quebec), from nine Canadian provinces, who participated in the 2016/2017 Canadian Student Tobacco, Alcohol and Drugs Survey. Psychological and social well-being (PSWB) was assessed using the Children's Intrinsic Needs Satisfaction Scale (CINSS). We conducted linear regression analyses to determine associations of sociodemographic, psychosocial and substance use variables with overall CINSS scores (n = 37 897).

In general, youth in Canada reported fairly high PSWB. After adjusting for all included variables, being in a higher grade, being bullied, bullying others, reporting more behavioural problems and using cigarettes, e-cigarettes or cannabis at least once in the past 30 days were associated with lower overall CINSS scores for both male and female students. Reporting more prosocial behaviours was associated with higher overall scores for both sexes.

A number of sociodemographic, psychosocial and substance use factors are associated with PSWB among youth in Canada. Prospective longitudinal and intervention studies could examine whether changes in these potential risk/protective factors are accompanied by changes in positive mental health.

A number of sociodemographic, psychosocial and substance use factors are associated with PSWB among youth in Canada. Prospective longitudinal and intervention studies could examine whether changes in these potential risk/protective factors are accompanied by changes in positive mental health.

COVID-19 infection significantly increased mortality risk and the burden of disability in most survivors, regardless of symptom severity at onset. The rehabilitation needs of people infected are receiving growing attention, as evidenced by the increasing number of publications, including those addressing the chronic consequences of infection. This rapid living systematic review reports the evidence published in November and December 2020 and summarises the entire body of literature on rehabilitation in COVID-19 patients published in 2020.

This update was performed using the methodology reported by the second edition conducted by Cochrane Rehabilitation REH-COVER Action. We searched PubMed, Embase, CINAHL, Scopus, Web of Science, and Pedro databases. Papers related to COVID-19 and rehabilitation were retrieved and summarised descriptively.

The search retrieved 4441 studies. After the removal of duplicates and the screening for title and abstract, we retained 105 studies. Of these, we included 54 in the q. High-quality-level studies on the efficacy of rehabilitation, and long-term monitoring of the disease and its sequelae are yet to emerge.

The update of the rapid living systematic review by Cochrane Rehabilitation Field demonstrates an increase in the level of evidence of studies addressing the rehabilitation needs associated with COVID-19 infection. Although most studies are still case reports/series, there is a trend towards conducting prospective investigations of the early natural history of the disease (first months post onset). High-quality-level studies on the efficacy of rehabilitation, and long-term monitoring of the disease and its sequelae are yet to emerge.A disorder of sex development (DSD) is defined as a congenital condition in which development of chromosomal, gonadal, or anatomical sex is atypical. Swyer syndrome is an example of 46,XY DSD with a female phenotype. It usually becomes apparent in adolescence with delayed puberty and amenorrhoea. Spontaneous breast development is very rare. A 15-year-old girl was presented due to primary amenorrhoea with breast development compatible with Tanner stage V. Hormonal tests revealed hypergonadotropic hypogonadism with low level of oestradiol. Pelvic ultrasound and magnetic resonance imaging revealed a small uterus, and no ovaries were found. In the right lower abdomen, a structure of unknown origin was visible. The chromosome analysis revealed a 46,XY karyotype. The patient was qualified for a laparoscopic bilateral gonadectomy. Postoperative histopathological examination revealed gonadoblastoma. We underline the need to consider DSD 46,XY in the presence of primary amenorrhoea, even when pubertal development is present. Germ cell tumors have a tendency to grow and metastasize rapidly. Delayed diagnosis may increase the risk of malignant transformation and cause a poor diagnosis.

To analyze the clinical features and SLC26A3 mutation of one patient in our hospital who had congenital loss of chlorine diarrhea (CLD), and to investigate the treatment of the disease and the prognosis.

By reviewing the literature, analyzing the clinical features and differential diagnosis and investigating the treatment and prognosis, the patient was diagnosed as CLD.

Excessive accumulation of amniotic fluid was observed during pregnancy. The patient was born prematurely with normal body weight. The patient was a4-month old boy admitted for anorexia, watery diarrhea, electrolyte disorders (hyponatremia, hypokalemia and hypochloremia) and metabolic alkalosis. The patient was also considered to be affected by Batter syndrome. After treating with spironolactone, indomethacin and potassium chloride sustained release tablet, the symptom of watery diarrhea was alleviated, the ingested amount of milk increased gradually and the amount of urine became normal; however, electrolyte imbalance persisted and the fetection and SLC26A3 genetic tests are helpful for diagnosis, and sodium chloride and potassium chloride replacement therapy are critical for the patient prognosis.

Persistent diarrhea and electrolyte disorder in pediatrics are easy to misdiagnose as CLD. Furthermore, it is difficult to identify Batter syndrome, Gitelman syndrome, renal tubular acidosis and CLD. Blood and stool electrolyte detection and SLC26A3 genetic tests are helpful for diagnosis, and sodium chloride and potassium chloride replacement therapy are critical for the patient prognosis.Type 1 diabetes is based on apoptosis, which leads to b-cell death. Factors triggering apoptosis processes are very diverse and currently not fully explained. The main role is attributed to genetic and environmental factors. Genetic studies have shown that the inherited propensity for type 1 diabetes is multi-genetic. Environmental factors modify the response to their own antigens, but are probably not necessary to start the autoaggression process. The effect of b-cell destruction is confirmed by the appearance of autoantibodies in the blood. The paper presents a review of the available literature regarding the self-destruction of pancreatic b-cells. The aim of the study was to draw attention to the extremely complicated and still unknown etiopathogenesis of type 1 diabetes by reviewing current literature related to the above topic. The goal is to acquire the knowledge necessary to develop and implement causal treatment for diabetes. At the moment, unfortunately, we do not have safe, innovative therapy methods in the field of diabetes prevention. Intensive research on the etiopathogenesis of type 1 diabetes is an extremely important field of medical research.Cardiopulmonary exercise test (CPET) is a kind of method that enables an integrated response to the physical effort of the different systems of children and adolescents organism. The field of clinical applications on children and adolescents is widen to assess impairment of physical capacity with an unclear cause and to objectively determine functional capacity. The higher consciousness of better interdependence between exercise tolerance and health condition than with resting measurements is crucial.

Knowledge of uterine and ovarian growth patterns during early age and puberty helps in investigating disorders of pubertal development i.e. precocious puberty, premature thelarche, or pubarche. There is apaucity of data for uterine and ovarian parameters. Aim of the study The aim of this study is to present normative data for Uterine length, Mean ovarian volume (MOV), and fundo cervical ratio (FCR) from 5 to 16 years in healthy girls from north India and to correlate these parameters with age, weight, height, and pubertal Tanner staging.

A cross-sectional observational study was performed on 130 healthy girls age 5 to 16 years. Age, anthropometric parameters were measured and the pubertal stage was categorized using Tanner staging. All subjects underwent pelvic ultrasonography for the measurement of uterine and ovarian parameters.

Normative data of uterine length, MOV, and FCR were presented as mean, SD, median, and 95% confidence interval as per age and Tanner stage. A progressive increase in uterine length, MOV & FCR was observed with increasing age, weight, height, and Tanner stage (p<0.001). A sudden significant increment in uterine length and MOV was observed between the age of 11-12 and 12-13 years (p<0.001). Uterine length of<4 cm, MOV<2 cm3 and FCR<1 were specific to identify pre-pubertal girls.

Normative data of uterine and ovarian parameters generated in our study by ultrasonography would be useful for screening girls with abnormalities of pubertal development.

Normative data of uterine and ovarian parameters generated in our study by ultrasonography would be useful for screening girls with abnormalities of pubertal development.

Homozygous familial hypercholesterolaemia (HoFH) carries agrave prognosis but is often underdiagnosed and undertreated. Confirmation of molecular diagnosis helps in planning effective management and determining prognosis accurately. Aim of the study To determine the spectrum of mutations in the LDLR gene in acohort of children with aclinical diagnosis of HoFH.

Genomic DNA was extracted from peripheral blood samples of 8 patients, who were children of either sex, aged under 16 years, and diagnosed clinically with HoFH using the Simon Broome criteria. The potential variants in the LDLR gene were analysed by Sanger sequencing.

Fifty variations were found in the 8 patients; 39 (78%) were single nucleotide variations while 8 (16%) and 3 (6%) were deletions and insertions, respectively. The pathogenic variants in the LDLR gene were detected in four patients; three showed duplication in exon 17 (c.2416dupG) creating an amino acid change at position 806 (p.Val806GlyfsTer11) while one had amissense variant in the exon 9 at position c.1285G>A resulting in achange in amino acid at position 429 (p.Val429Met). The variants were found in heterozygous state in the parents or siblings of probands who showed pathogenic variants.

The frequency of disease-causing variants in the LDLR gene in our patients with HoFH was 50%. Further studies to characterise mutations in genes for apolipoprotein B, proprotein convertase subtilisin/kexin type 9, or LDL adaptor protein are suggested in all children with aclinical diagnosis of HoFH.

The frequency of disease-causing variants in the LDLR gene in our patients with HoFH was 50%. Further studies to characterise mutations in genes for apolipoprotein B, proprotein convertase subtilisin/kexin type 9, or LDL adaptor protein are suggested in all children with a clinical diagnosis of HoFH.

Being born small for gestational age (SGA) implies an increase in the childhood morbidity and mortality rates, in addition to being related to changes in the pattern of growth and body composition, which may be associated with the development of risk factors linked to metabolic diseases. Aim of the study To describe the development of anthropomorphic indicators of children born at full term, small (SGA) or appropriate for gestational age (AGA), up to the sixth month of life, and again when they reached school-age.

This was aprospective cohort study, with 31 children (19 SGA, and 12 AGA), recruited in public maternity hospitals. Subsequently they were attended at an outpatient clinic on amonthly basis, by amultidisciplinary team in the first year of life. These children were re-evaluated when they reached school-age.

Both groups showed high percentages of exclusive breastfeeding in the first months of life. Group SGA showed intense early recovery of the growth indicators, characterizing recovery of growth in the first 6 months of life. However, at school-age, they were still smaller, lighter, with alower quantity of body fat and muscle mass than those born AGA. There was predominance of appropriate anthropometric growth and body composition indicators at school-age, even in Group SGA. Conclusion At school-age, the children of this study showed no major alterations related to anthropometry.

Both groups showed high percentages of exclusive breastfeeding in the first months of life. Group SGA showed intense early recovery of the growth indicators, characterizing recovery of growth in the first 6 months of life. However, at school-age, they were still smaller, lighter, with a lower quantity of body fat and muscle mass than those born AGA. There was predominance of appropriate anthropometric growth and body composition indicators at school-age, even in Group SGA. Conclusion At school-age, the children of this study showed no major alterations related to anthropometry.

To assess the response of South Indian children with growth hormone deficiency (GHD) to growth hormone therapy, optimal duration of therapy for good catch up, and factors determining the response of our children to growth hormone therapy.

We conducted acase control study at apaediatric endocrine unit of atertiary paediatric hospital. Children diagnosed with growth hormone deficiency were initiated on GH (cases) or followed up without GH therapy (controls). Detailed clinical, biochemical, radiological, and treatment parameters were recorded at baseline and follow-up. Data were analysed using IBM SPSS version 21.

We enrolled 23 subjects in group I (cases who received GH) and group II (controls with untreated children), and both the groups were comparable at baseline. Group I (-4.12 ±1.7 to -2.81 ±1.52) had significant height increase on follow-up after GH therapy compared to group II (-3.55 ±1.7 to -3.51 ±1.52) (p>0.05). Growth velocity in group I (13.25 ±5.6 cm/year, SD score 4.55 ±5.42) was significantly higher compared to group II (3.4 ±1.8 cm/year, SD score -1.62 ±2.38). Duration of growth hormone therapy, presence of ectopic posterior pituitary, and BA CA ratio independently impacted the growth velocity SD scores. Kaplan Meier analysis curve showed 15 months of GH therapy was needed to attain aheight within ±2 SD of the target height.

Early diagnosis, pre-pubertal status, delayed bone age, and presence of ectopic posterior pituitary on MRI are determinants of abetter response. Growth hormone must be administered for at least 15 months for catch up height SDs within target height SD range.

Early diagnosis, pre-pubertal status, delayed bone age, and presence of ectopic posterior pituitary on MRI are determinants of a better response. Growth hormone must be administered for at least 15 months for catch up height SDs within target height SD range.

Some studies reported that essential fatty acids deficiencies can be related to autism spectrum disorders (ASD) in children. This study aimed to investigate the effect of omega-3 on social, verbal, and behavioral activities in ASD children.

A double-blind, randomized clinical trial study was conducted on 54 children with autism, who were assigned to the case (n = 28) and control (n = 26) groups. The cases received one capsule of 1000 mg omega-3 daily and the controls received one capsule of 1000 mg medium chain triglyceride daily as placebo for eight weeks. The Gilliam Autism Rating Scale-second edition (GARS-2) was used to assess the severity of autism and food frequency questionnaire (FFQ) was used to assess their dietary intake. All measurements were done at baseline and after the intervention.

After adjusting for age, gender, birth weight, BMI, dietary intake, mother's age, and mother's BMI, the intervention group had significantly improved stereotyped behaviors (p = 0.02), social communication (p = 0.02), and the GARS score (p = 0.001) after the intervention compared to the control group. No significant change was found in the score of social interaction subscale.

The findings indicate that omega-3 treatment improved autism characteristics including stereotyped behaviors and social communication. Further studies are needed to confirm these findings and to determine the underlying mechanisms.

The findings indicate that omega-3 treatment improved autism characteristics including stereotyped behaviors and social communication. Further studies are needed to confirm these findings and to determine the underlying mechanisms.

Currently, 5-10% of diabetes patients are teenagers. During this period the influence of peers and observation of their eating habits plays a significant role. Unfortunately, they differ from the principles of proper nutrition, which according to the PTD Diabetes Poland should be introduced as an element of proper metabolic compensation. Aim of the study To assess the condition and dietary habits of male adolescents with type 1 diabetes and to compare their eating habits to generally accepted standards.

The study participants include 20 boys, aged 14.6 ±1.58 years, with type 1 diabetes mellitus treated with a personal insulin pump who were diagnosed using ISPAD criteria. In the study anthropometric and questionnaire methods were used, as well as body composition analysis.

In most of the examined subjects, the assessment of nutritional status indicates a proper proportion of adipose tissue (14.72 ±6.25%, 8.71 ±4.10 kg per kg) and muscle mass in the body (28.2 ±6.93 kg). Unfortunately in a significant group of adolescents, the diet is not properly balanced. Particularly the common problem is the excess of total carbohydrates, including simple sugars.

To sum up, despite systematic education of proper nutrition on glycemic control and prevention of acute and chronic complications, the eating habits of male adolescents differ from those of proper nutrition. Additionally, it should be noted that despite the proper results of the body composition analysis, there is a problem with an erroneously balanced diet.

To sum up, despite systematic education of proper nutrition on glycemic control and prevention of acute and chronic complications, the eating habits of male adolescents differ from those of proper nutrition. Additionally, it should be noted that despite the proper results of the body composition analysis, there is a problem with an erroneously balanced diet.

The aim of our study was to analyze the incidence and the clinical characteristic of celiac disease (CD) in pediatric population with type 1 diabetes mellitus (T1DM).

The data of 880 patients with T1DM, 429 girls, mean age 12.14 ±4.0 years was retrospectively retrieved from medical records. Patients with T1DM and CD were selected and a detailed analysis of CD prevalence and its clinical characteristic at the time of CD diagnosis was performed. The data were compared with the previous data from our center published a decade ago.

CD was suspected in 85/880 patients (9.65%) on the base of results of serological tests, but finally CD was diagnosed in 73/880 patients with T1DM (8.3%), in 53/429 girls (12.3%) and in 20/451 boys (4.4%). Most patients (71%) had CD diagnosed after T1DM onset. The majority of CD patients (72%) was asymptomatic. The CD diagnosis was not associated with inappropriate metabolic control of diabetes. The onset age of diabetes in children with CD was significantly lower than in those without CD (5.8 ±3.6 years vs. 7.56 ±4.0 years, p=0.04). The prevalence of CD is significantly higher than adecade ago in our center (8.3% vs. 5.7%, p=0.001).

In light of increasing prevalence of mainly asymptomatic CD in patients with T1DM, CD screening is necessary. However positive serological tests, which are currently used in screening, and are the first step of diagnostics, in some patients allow only to suspect the CD and further diagnostic steps should be performed.

In light of increasing prevalence of mainly asymptomatic CD in patients with T1DM, CD screening is necessary. However positive serological tests, which are currently used in screening, and are the first step of diagnostics, in some patients allow only to suspect the CD and further diagnostic steps should be performed.This article retraces the nephrological life of Giovanni Barbiano di Belgiojoso, which started in the late 1960s. Since the beginning renal pathology was his main interest and he was among the pioneers who introduced in Italy the use of immunofluorescence technique in the examination of renal biopsies. Over the years Barbiano di Belgiojoso has carried out, often in cooperation with other nephrological groups, many clinico-pathological studies on a wide spectrum of glomerular diseases. He also played a key role in the foundation and in the activities of the "Group of Renal Immunopathology" of the Italian Society of Nephrology.Background Living donor kidney transplantation (LDKT) is the treatment of choice for end stage renal disease. LDKT involves complex psychosocial issues, which remain partially unexplored. Methods The study involved all potential living donors and recipient pairs consecutively referred for psychosocial evaluation from the nephrologist. Clinical and sociodemographic variables including prior psychiatric history, previous and current use of psychopharmacological therapy, motivation and information about the transplant procedure were collected. Study participants completed the Symptom Checklist-90-R (SCL-90-R) to assess psychopathological distress. Results Fifty-three donor/recipient pairs underwent psychiatric and psychological evaluation. Seven subjects (13%) in the recipient group and 13 subjects (25%) in the donor group reported a history of psychological distress and/or psychiatric conditions. A psychiatric diagnosis was confirmed in 4 recipients (7.5% of the study sample, including autism spectrum disorder, histrionic personality disorder, and anxiety-depressive disorders) and 5 donors (9%, including narcissistic personality disorder in one case and anxiety-depressive disorders). SCL-90-R GSI mean scores were 0.3 ±0.3 and 0.2 ±0.2 for the recipient and donor groups, respectively. Overall, 8 couples (15%) suspended the living donation pathway before transplantation. Four couples were excluded for a new onset medical condition. The psychological and psychiatric evaluation excluded one candidate. One couple dropped out before completing the scheduled exams. One recipient refused to undergo crossover renal transplantation, while 1 donor candidate withdrew her consent for transplantation at the end of the evaluation process. Conclusions Limited but significant psychopathological distress in donors and recipients supports the usefulness of psychiatric and psychological competencies within the transplant team.Despite being recommended by most guidelines, the metabolic evaluation of patients with nephrolithiasis has limited diffusion due to difficulties relating both to the access to laboratory investigations and to urine collection modalities. Consequently, in addition to the classical 24-h collection, alternative and simplified collection modes have been proposed. We report here on the comparison between metabolic evaluation carried out on 24-h double collection (Lithotest) and overnight spot urines (RF test). Fifty-four patients with stone disease were enrolled, excluding patients with infection or cystine stones. For Lithotest, we measured all analytes necessary to calculate state of saturation (ß) with calcium oxalate, brushite and uric acid, by means of Lithorisk.com. For RF, we measured calcium, magnesium, oxalate, citrate, sulphate, phosphate, pH and creatinine. The comparison was made with creatinine ratios. An estimate of ßCaOx, ßbrushite and ßAU was obtained also on RF urines by using simplified algorithms. We found highly significant correlations between all parameters, despite quite different means. There was a nice correspondence between the two sets of measurements, assessed by the Bland-Altmann test, for calcium, oxalate, citrate, sulphate, urate and pH. Overnight urine had higher saturations compared to 24-h one owing to higher concentration of the former. In conclusion, RF test on overnight urine cannot completely replace Lithotest on 24-hr urine. However, it can represent a simplified tool for either preliminary evaluation or follow-up of patients with stone disease.Introduction and aims Stages 4 and 5 of chronic kidney disease (CKD) have always been considered hard to modify in their speed and evolution. We retrospectively evaluated our CKD stage 5 patients (from 01/1/2016 to 12/31/2018), with a view to analyzing their kidney function evolution. Material and Methods We included only patients with longer than 6 months follow-up and at least 4 clinical-laboratory controls that included measured Creatinine Clearance (ClCr) and estimated GFR with CKD-EPI (eGFR). We evaluated the agreement between ClCr and eGFR through Bland-Altman analysis; progression rate, classified as fast (eGFR loss >5ml/min/year), slow (eGFR loss 1-5 ml/min/year) and non-progressive (eGFR loss 5 ml/min/year). The vast majority showed a slow progression, stabilisation or even an improvement. Despite the limits due to the small sample size, the data has encouraged us not to consider CKD stage 5 as an inexorable and short journey towards artificial replacement therapy.Waldenström's disease is a rare haematological neoplasm involving B lymphocytes, characterized by medullary infiltrated lymphoplasmacytic lymphoma and by the presence of a monoclonal M paraprotein. Although rarely, this condition may lead to heterogeneous renal involvement and cause severe renal failure. We report the clinical case of a patient with overt nephrotic syndrome in Waldenström's disease treated with a combination chemotherapy (rituximab, cyclophosphamide, dexamethasone) until complete renal and haematological remission.Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) are rare autoimmune diseases characterised by medium and small vessels inflammation. Renal vasculitic involvement is one of the most severe manifestations, with high mortality in case of a delayed diagnosis and a significant impact on patients' long-term prognosis. Histological classifications and scores for the definition of renal involvement in AAV exist and correlate with the renal outcome. Current induction regimen consists of a high dose of glucocorticoids and immunosuppressive drugs cyclophosphamide (CYC), rituximab (RTX) or a combination of both. RTX use is expanding thanks to randomised control trials suggesting its non-inferiority compared to the standard CYC therapy in general AAV and a better safety profile; its cost has also reduced thanks to the availability of biosimilars. However, the equivalence of RTX and CYC in patients with severe renal involvement is still debated. The quest for the ideal induction regimen in AAV is moving towards a more personalized approach on the one hand, efforts are made to use already existing therapies in the most appropriate way; on the other, new insights into AAV pathogenesis has allowed the discovery of new targets, such as the complement factor C5a. Thanks to this new AAV management, renal outcome and overall survival has visibly improved. New studies are needed to reach a more personalized approach in the induction regimen of ANCA-associated glomerulonephritis and AAV in general.Infections continue to be a major cause of morbidity and mortality in patients on renal replacement therapy with peritoneal dialysis (PD). Despite great efforts in the prevention and treatment of infective complications over the two past decades, catheter-related infections represent the most relevant cause of technical failure. Recent studies support the idea that exit-site/tunnel infections (ESI/TI) have a direct role in causing peritonitis. Since the episodes of peritonitis secondary to TI lead to catheter loss in up to 86% of cases, it is advised to remove the catheter when the ESI/TI does not respond to medical therapy. This approach necessarily entails the interruption of PD and, after the placement of a central venous catheter, the shift to haemodialysis (HD). In order to avoid the change of dialytic method, the simultaneous removal and replacement (SCR) of the PD catheter has also been proposed. Although SCR avoids temporary HD, it requires the removal/reinsertion of the catheter and the immediate initiation of PD, with the risk of mechanical complications such as leakage and malfunction. Several mini-invasive surgical techniques have been employed as rescue procedures curettage, cuff-shaving, the partial reimplantation of the catheter and the removal of the superficial cuff with the creation of a new exit-site. These procedures allow to save the catheter and have a success rate of 70-100%. Therefore, in case of ESI/TI refractory to antibiotic therapy, a mini-invasive surgical revision must always be considered before removing the catheter.Currently, CEUS (Contrast-Enhanced UltraSound) is used in the evaluation of different organs and systems. It offers valuable information about vascular disease, both on a macro- and a micro-vascular level, and has a series of well-established applications in the monitoring of adult patients; official guidelines and recommendations are also available. Its use in a nephrological setting is constantly growing thanks to the lack of nephrotoxicity of the contrast agent, the absence of ionizing radiation and the possibility of characterizing focal pathologies, for diagnosis and in clinical practice. We describe here 3 clinical cases relating to renal diseases and we review the relevant literature with a specific focus on the use of CEUS in a nephro-urological setting.Considerable efforts have been undertaken to quickly develop COVID-19 vaccines that protect vulnerable adults against severe disease and thus limit the socio-economic and public health impact of the current pandemic. To justify COVID-19 vaccination for the pediatric population, which rarely suffers from severe COVID-19, vaccines will need to have fully demonstrated safety and efficacy in preventing complications and viral transmission. This article summarizes the different vaccine platforms that are currently being tested and discusses practical and ethical aspects of childhood COVID-19 vaccination. It also examines the already deleterious effects of the pandemic on routine childhood vaccine coverage and insists on the imperative to vaccinate all children timely as recommended by national immunization programs.In this article, the authors, a pediatrician/child psychiatrist and two psychiatrists trained in systemic family therapies, share their reflections on the psychological effects of the COVID-19 pandemic on children and family ties. The therapists review the literature, draw upon their clinical experience during the first wave of the pandemic to suggest some guidelines for this second wave. A clinical case illustrates their practice with an example of family resilience. The importance of the healthcare network in strengthening family resilience is also highlighted.Although SARS-CoV-2 infects individuals of all ages, children show less severe symptoms. Nevertheless, the very rare COVID-19 severe cases in paediatrics require our full attention. Much research has been conducted and is still ongoing on effective treatments. On the antiviral front, no molecule has been proven effective yet and the results of several studies on the benefit of monoclonal antibodies and convalescent plasma are pending. On the side of immunomodulators, the benefit of steroids has been demonstrated for patients severely ill. Other molecules are being investigated. However, all these studies focused on adults and paediatric data are warranted.Some uncertainties remain regarding SARS-CoV-2 diagnostic procedures and seroprevalence studies in children. RT-PCR assays conducted on nasopharyngeal (NP) swabs remain the gold standard for SARS-CoV-2 diagnostic in children as in adults. Saliva samples might replace soon NP swabs as similar sensitivities have been reported from both samples in adults, but not yet in children. Rapid antigen testing is currently performed on NP swabs collected from children within 4 days of their symptom onset. Serology testing is an essential diagnostic tool in seroprevalence studies, which might guide in the future public health decisions.Children appeared to be initially spared by the SARS-CoV-2 pandemic, however, in spring 2020, a new clinical entity was described related to the SARS-CoV-2 infection and named multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS). The gravity of this inflammatory syndrome, the time interval between infection and MIS-C, the response to the various immunomodulatory treatments are all suggestive of an immunologic reaction rather than a virus-mediatred phenomenon. The pathophysiological mechanisms and possible risk factors for MIS-C have not been elucidated. In this article, we summarize what is known to date about the immune response to SARS-CoV-2 in children and about the immune response to SARS-CoV-2 in children and about the MIS-C.