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5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (ORadj = 3.44, 95%CI 2.22-5.32, p less then 0.001 and 2.62, 95% CI 1.63-4.22 p less then 0.001, respectively) compared to Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadj = 3.81, 95%CI 2.25-6.45, p less then 0.001). Treatment success in group A reached only 79.8% (568/712) with 7-14 days triple therapy tailored to antibiotic susceptibility. Conclusion Peptic ulcers are rare in dyspeptic H. pylori infected children. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.Juvenile polyps are the most common gastrointestinal polyps in childhood. Typically, they are located in the colon and present with intermittent and painless hematochezia. A few case reports have described juvenile polyps in the small intestine, all presenting as intussusception requiring surgery. We report an isolated juvenile polyp in the small intestine presenting with painless anemia, identified using video capsule endoscopy, and removed via enteroscopy.Objectives Esophageal dysmotility is common in patients with esophageal atresia (EA). High-resolution impedance manometry (HRIM) and Pressure Flow analysis (PFA) allow characterization of biomechanical events that drive bolus flow. The aims were to assess esophageal motility in children with EA, using pressure flow analysis, and to test whether there is a correlation between PFA parameters and symptoms or endoscopic/histologic findings. Methods HRIM was performed in 16 children with EA (median age 11 years), compared with 13 patient controls (median age 14 years; p=NS vs patients). Wet swallows were analyzed using PFA. Medical charts were reviewed for symptoms and pathology results of the attendant esophagoscopy. learn more EA patients were arbitrarily sub-grouped according to their motility pattern Group A with presence of distal contraction in ≥ 50% of the swallows and Group B with presence of distal contractions in less then 50% of the swallows. Results Esophageal peristaltic motor patterns were abnormal in all EA patients. Bolus transport was impaired as shown by the higher impedance Ratio (IR) in EA than in controls (0.47 vs 0.22 p less then 0.001). IR was also higher in Group B (n = 8) versus Group A (n = 8) (p less then 0.001). Symptoms of dysphagia were not correlated with the PFA measures. Contractile segment impedance (CSI), a marker of mucosal integrity, was significantly lower in the EA group. Conclusions Bolus transport was severely altered in EA patients but was not predictive of symptoms. The presence of residual distal contractions is associated with a more efficient bolus propulsion.Introduction Contemporary pediatric data on pouch outcomes are sparse, especially in the era of laparoscopic surgeries. We aimed to assess outcomes and predictors in children with ulcerative colitis (UC)/inflammatory bowel disease (IBD)-unclassified who underwent colectomy and ileal-pouch-anal-anastomosis (IPAA). Methods This was a multicenter retrospective cohort study from 17 IBD centers affiliated with the Pediatric IBD Porto-group of ESPGHAN. An electronic REDcap system was used to collate baseline characteristics, demographic, clinical, management and surgical data, short and long-term outcomes, and to identify potential predictors of pouch outcome. Results Of the 129 patients included, 86 (67%) developed pouchitis during follow-up of median 40 months (IQR 26-72), of whom 33 (26%) with chronic pouchitis. Patients operated on by surgeons performing less then 10 pouch surgeries/year had a higher rate of chronic pouchitis (11/27 (41%) vs 8/54 (15%), p = 0.013) on both univariable and multivariable analyses and also associated with time to pouchitis (p = 0.018) and chronic pouchitis (p = 0.020). At last follow-up, overall pouch performance was rated good/excellent in 86 (74%) patients. Time from colectomy to pouch formation was not associated with pouch outcomes. Despite higher rate of non-severe surgical complications among children undergoing colectomy at less then 10 years of age (7/16 (44%) vs 10/92 (11%), p = 0.003), functional outcome and pouchitis rate did not differ. Conclusions Pouchitis rate in children with UC/IBDU is high. Surgeon experience is the major modifiable risk factor for pouch outcome. Our analyses suggest that pouch surgery can also be performed successfully in young children.Purpose To describe the use of glycerine in improving media clarity in cases with edematous cornea. Methods Retrospective case-series including patients with posterior segment pathologies needing surgical invention and having corneal edema. Each case was studied for the role of topical application of glycerine instead of viscoelastic agents and the course of surgery. The cases were followed up for minimum 3-months duration. Results Six cases with corneal edema having posterior segment pathology underwent surgery with intraoperative topical application of glycerine. The corneal edema was seen to clear with progression of surgery and was maintained until the end of surgery. Procedures like vitreoretinal surgery, identification of break, internal limiting membrane peeling, intraocular lens explantation, scleral indentation, DSEK graft removal, and subretinal band removal could be performed in these cases. Conclusion Intraoperative glycerine use during vitreoretinal surgeries is helpful in improving the corneal clarity and maintaining it till the end of surgery.Although the number of older people living with HIV (PLWH) is growing, prior research has focused on older PLWH as care recipients and psychosocial factors (e.g., stigma, social support) associated with their HIV care. Literature on HIV caregiving mainly focuses on family members providing care to PLWH or children of parents with HIV. There is a gap in the literature in terms of older PLWH's roles as caregivers to their family members. Thanks to combination antiretrovirals that help PLWH live longer and have healthier lives, many older PLWH now find themselves in a position to provide care to family members. To help older PLWH age successfully, it is important to understand their role as caregivers while they juggle responsibilities with their own health care needs. This article elucidates this gap in the literature on older PLWH who are caregivers and provides direction for a research agenda and potential clinical implications.Preexposure prophylaxis (PrEP) is highly effective in preventing HIV among both men and women, with the reduction in risk directly linked to medication adherence. Navigation services and other adherence interventions have demonstrated efficacy in medication uptake; however, their use may not be fully integrated into clinic operations or their roles clearly defined. This quality improvement (QI) project developed an evidenced-based PrEP Navigation (PN) tool to identify patient-reported barriers to uptake and to support process improvement at a large community health center in Washington, DC. Outcomes related to patient-reported barriers, patient demographics, and time to medication pickup from the pharmacy were measured before and after implementation. A total of 198 patients were included in this analysis. Mean days from initial prescription to medication pickup was reduced by 1.42 days (p = .030) following PN tool implementation. The evidenced-based PN tool is modifiable to the needs of the individual clinic and the patients they care for to support wide-scale PrEP uptake and continuous system process improvements.Purpose To investigate central endothelial cell density (ECD), morphology, and central corneal thickness (CCT) in patients newly diagnosed with severe obstructive sleep apnea-hypopnea syndrome (OSAHS) and to determine the correlation between these parameters and OSAHS severity. Methods This prospective, comparative case series was conducted in a university ophthalmology clinic. In total, 51 patients recently diagnosed with severe OSAHS (apnea-hypopnea index above 30) and a paired, age and sex-matched control group of 44 healthy individuals were enrolled. After detailed ophthalmologic examination, specular microscopy measurement was performed for all participants. Central ECD, average cell area, coefficient of variation (CV) of cell area, hexagonal cell appearance ratio (% Hex), and CCT were compared between the groups. The Pearson correlation test was also used to assess the influence of the polysomnographic findings, that is, the proportion of each stage of sleep, apnea-hypopnea index, SpO2, mean and maximum duration of apneas, oxygen desaturation index, and arousal index on corneal endothelial morphometric parameters and CCT. Results A total of 190 eyes were examined 102 eyes of patients with severe OSAHS and 88 eyes of the control group. The mean ECD, CV, % Hex, and CCT values in the OSAHS group were 2439.25 ± 344.36 cells/mm, 41.41 ± 11.62, 45.22 ± 7.06%, and 533.88 ± 40.53 μm, respectively. ECD and CCT did not significantly differ between the groups (P = 0.46, P = 0.55, respectively). CV value was significantly higher (P = 0.009), whereas the %Hex was significantly lower (P = 0.01) in the OSAHS group. We observed a significant negative correlation between CCT and REM sleep percentage (P = 0.005). Conclusions Greater pleomorphism and polymegathism of corneal endothelium was found in patients with severe OSAHS when compared with healthy subjects. Low percentage of REM sleep, usually found in patients with OSAHS, may cause an increase in corneal thickness.Purpose To present the baseline data for a large cohort of patients with keratoconus enrolled in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) study. Methods Eight centers contributed the Scheimpflug tomographical data for 906 patients with keratoconus, 743 measured with a Pentacam and 163 with a Galilei. The stage of keratoconus at baseline, the location of the reference points, minimum pachymetry (Pmin), and maximum keratometry (Kmax) were analyzed. The intereye asymmetry was evaluated for Kmax (anterior and posterior), Pmin, and keratoconus stage. Average maps and elevation profiles were calculated for each degree of keratoconus. Results Keratoconus was more frequently diagnosed in men (73%) than in women (27%). At baseline, 500/1155 eyes (43%) presented with moderate to severe changes in the posterior surface, whereas moderate/severe changes were only found in 252 and 63 eyes when evaluating anterior surface and pachymetry, respectively. The location of Pmin was usually inferotemporal (94% OD and 94% OS), while the location of Kmax showed more variability and significantly higher distance from apex (P less then 0.05). The keratoconus presentation was chiefly asymmetric for all the parameters studied. Clear differences between stages could be identified in the maps and elevation profiles. Conclusions The staging map set presented can be used as a graphical guidance to classify keratoconus stage. Keratoconus presented asymmetrically, and generally the posterior surface was more affected than the anterior surface or the thickness. Asymmetry is playing a role in KC detection. Although Pmin was almost invariably located inferotemporally, Kmax location showed higher variability and distance from the apex.