In recent decades, an increasing number of gender-nonconforming children and adolescents have been presenting to healthcare system worldwide. The pediatric practice is often the first point of contact for those affected....In recent decades, an increasing number of gender-nonconforming children and adolescents have been presenting to healthcare system worldwide. The pediatric practice is often the first point of contact for those affected. To date, it is unclear what challenges and difficulties pediatricians face in caring for gender-variant children and adolescents. Qualitative interviews were conducted using a semi-structured guideline to analyze the care situation from the perspective of practicing pediatricians. Sample: 32 German pediatricians in private practice.Pediatricians described that children and adolescents with gender dysphoria show increased self-confidence and are more likely to open up and confide during consultations. At the same time, there was a lack of expertise regarding the etiology and diagnosis of gender dysphoria. Concerns were expressed about the irreversibility and possible long-term consequences of physical medical interventions for gender incongruence. Pediatricians encounter challenges when it comes to connecting their gender-variant patients to other healthcare services. It was suggested that counselling offers for children and adolescents experiencing gender dysphoria should be expanded.The pediatricians who participated in the study displayed a lack of certainty regarding the care of gender-nonconforming children and adolescents, as well as the care concepts employed by specialized care services.It is necessary that pediatricians receive enhanced awareness and training in order to ensure appropriate care for children and adolescents with gender dysphoria. Furthermore, it is essential to establish transparent care structures to achieve effective cooperation between routine and specialized care.
Short bowel syndrome (SBS) results from a severe reduction in intestinal absorptive capacity, rendering it insufficient to meet the body's nutritional requirements. Teduglutide represents a novel therapeutic approach for...Short bowel syndrome (SBS) results from a severe reduction in intestinal absorptive capacity, rendering it insufficient to meet the body's nutritional requirements. Teduglutide represents a novel therapeutic approach for patients with SBS. This study aims to share our experiences and outcomes of Teduglutide treatment in children with SBS, focusing on the development of their anthropometric parameters.This study included all pediatric SBS patients in the Czech Republic receiving home parenteral nutrition (PN) who began Teduglutide treatment from May 2019 to June 2024.We analyzed the changes in volume and caloric content of PN and anthropometric parameters for each patient.All 10 patients showed a reduction in PN volume and caloric content during Teduglutide treatment with a mean value 67%+/- 29. There was also a notable decrease in the caloric content of PN, although this did not always correlate with the volume reduction, the mean value was 52.3%+/- 40.6. Despite the reduced reliance on PN, there was a mean improvement in weight and height among the patients. Gastrointestinal complications were the most common side effects observed.Our findings confirm the positive impact of Teduglutide on intestinal absorption in pediatric SBS patients. They also validate its safety and efficacy in this population. Despite the reduction in PN, improvements in weight were evident across the entire patient cohort.
Acute paediatric community-acquired pneumonia (pedCAP) represents a significant burden on child health and highlights the need for accurate diagnostic tools. This study aimed to differentiate between acute community-acqu...Acute paediatric community-acquired pneumonia (pedCAP) represents a significant burden on child health and highlights the need for accurate diagnostic tools. This study aimed to differentiate between acute community-acquired viral and bacterial pedCAP using TRAIL, IP-10, and MxA markers.The study a single-center prospective study was conducted between January 2019 to January 2020. During the follow-up period, 315 patients with paediatric community-acquired pneumonia were followed up. The analysis was performed with 52 patients aged 5 years and younger in whom pathogens were detected. 24 control groups were also included to see the change of markers in intact subjects. The patients' medical history and samples were obtained upon hospital admission or within the first day.The mean values of MxA, TRAIL, and IP-10 differed significantly among all three groups (all p values p<0.01). The ROC analysis indicated that serum MxA, TRAIL, and IP-10 parameters had diagnostic value in predicting the differentiation of viral pedCAP from bacterial pedCAP .The TRAIL, MxA, and IP-10 markers have diagnostic value in distinguishing viral pneumonia and bacterial pneumonia. Among these markers, MxA exhibits the highest sensitivity. High levels of MxA, TRAIL and IP-10 in combination with low C-reactive protein (CRP), procalcitonin (PCT) and neutrophil lymphocyte ratio (NLR) values to differentiate viral from bacterial pedCAP will significantly contribute to the accurate identification of viral LRTI.
Obesity, linked to various comorbidities like metabolic syndrome (MS) due to its proinflammatory nature, contributes to elevated exhaled nitric oxide levels, impacting multiple physiological systems, including the respir...Obesity, linked to various comorbidities like metabolic syndrome (MS) due to its proinflammatory nature, contributes to elevated exhaled nitric oxide levels, impacting multiple physiological systems, including the respiratory system. This study aimed to examine the impact of obesity and MS on lung function and airway inflammation in adolescents. We investigated the relationship between body fat distribution and pulmonary function parameters, and assess fractional exhaled nitric oxide (FeNO) levels as an indicator of airway inflammation.This study included 100 children aged 10 to 18 years, comprising 50 obese individuals and 50 non-obese healthy controls. Participants were categorized based on their relative body mass index (RBMI), presence of MS, and body fat distribution. Pulmonary function tests and FeNO levels were compared between the groups.The FEV1/FVC and FRC values were significantly lower in the obese group. Among obese participants, MS was present in 30%, and those with MS had higher ERV. In male subjects, FEV1/FVC was lower and FeNO levels were higher in those with increased waist circumference. There was a positive correlation between RBMI and FVC, TLC, and a negative correlation between RBMI and FEV1/FVC, FRC. Negative correlations were also detected between waist and neck circumferences and FEV1/FVC, FRC, RV values.Obesity and MS negatively impact pulmonary function, particularly reducing FEV1/FVC and FRC. Furthermore, central adiposity may contribute to airway inflammation, as indicated by increased FeNO levels.
Berner R, Ravens-Sieberer U, Strahwald B
… +12 more, Blankenburg J, Kaman A, Topf S, Li LY, Pfadenhauer L, Strelow L, Weyersberg A, Krägeloh-Mann I, Rothenbacher D, Rudolph H, De Bock F, Rehfuess EA
This guideline is concerned with measures to prevent and control the transmission of SARS-CoV-2 in primary and secondary schools, addressing school premises and all school-related activities, as well as routes to and fro...This guideline is concerned with measures to prevent and control the transmission of SARS-CoV-2 in primary and secondary schools, addressing school premises and all school-related activities, as well as routes to and from school.This evidence- and consensus-based S3 guideline was registered with the AWMF and developed by guideline panelists representing a broad range of scientific societies across multiple disciplines, public health and educational institutions, as well as associations of those directly affected, notably teachers, students and parents.This guideline contains recommendations on hybrid learning and cohorting of classes or students, wearing masks, measures on the way to school and in class, managing suspected cases and contact persons in schools, options for reducing aerosol concentrations in classrooms and testing strategies. In developing these, the guideline panel considered: balance of health benefits and harms, legal aspects, socio-cultural acceptability, health equity and non-discrimination, social and ecological consequences, financial and economic consequences and feasibility.
The clinical course of neuroblastoma is more heterogeneous than any other malignant disease. Many low-risk patients experience regression after limited or even no chemotherapy. However, more than half of high-risk patien...The clinical course of neuroblastoma is more heterogeneous than any other malignant disease. Many low-risk patients experience regression after limited or even no chemotherapy. However, more than half of high-risk patients die from disease despite intensive multimodal treatment. Precise disease characterization for each patient at diagnosis is key for risk-adapted treatment. The guidelines presented here incorporate results from national and international clinical trials to produce recommendations for diagnosing and treating neuroblastoma patients in German hospitals outside of clinical trials.
Midwives as well as medical doctors may carry out the initial examination of a newborn after birth in accordance with German health care regulation and guidelines. However, it is unclear which profession based on which q...Midwives as well as medical doctors may carry out the initial examination of a newborn after birth in accordance with German health care regulation and guidelines. However, it is unclear which profession based on which qualification is performing these examinations in current clinical practice.The aim of the study was to assess which professions are carrying out the initial examinations of a newborn in the largest German maternity hospitals as of today.University maternity hospitals and maternity hospitals with more than 2000 births in 2021 were asked to anwer a webbased questionnaire. A chi-square test was used for group comparisons.77 out of 111 contacted maternity hospitals participated. In total, five different professions carry out Apgar scores and the initial neonatal examinations in a healthy newborn in the largest German maternity hospitals. In 92% of maternity hospitals, midwives regularly collect Apgar scores. In most hospitals, initial examinations of the newborn are also regularly carried out by midwives (74%), but significantly less often than Apgar scores (p≤0,001). University and non-university maternity hospitals do not differ significantly in the rate at which midwives performed Apgar scores (93.9% vs. 90.9%, p=0.623) and initial examinations of the newborn (72.7% vs. 75%, p=0.822).Midwives are the predominant medical profession carrying out initial examinations of the newborn in German maternity hospitals as of today. Thus, they should also be the primary target group for quality assurance and quality improvement measures for these examinations in in the future.
This study aimed to compare the nasal continuous positive airway pressure (nCPAP) and bi-level positive airway pressure (BiPAP) in preterm infants with respiratory distress syndrome (RDS).Preterm infants (≤32 weeks of ge...This study aimed to compare the nasal continuous positive airway pressure (nCPAP) and bi-level positive airway pressure (BiPAP) in preterm infants with respiratory distress syndrome (RDS).Preterm infants (≤32 weeks of gestation) were randomly assigned, at birth, into two study groups: nCPAP or BiPAP. Primary outcomes (surfactant administration and failure of non-invasive respiratory support within the first 72 hours), and secondary outcomes (duration of ventilation support, pneumothorax, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, intraventricular haemorrhage, retinopathy of prematurity, time to total enteral feeding, length of hospital stay, and mortality) were assessed.A total of 188 preterm infants with RDS were analysed. Mean gestational age was 28.8±1.8 weeks (nCPAP) versus 29±1.9 weeks (BiPAP). There were no statistically significant differences between groups in the failure of non-invasive respiratory support (25% vs. 33%, RR: 0.74, 95% CI: 0.47-1.17) or surfactant administration (35% vs. 38%, RR: 0.92, 95% CI: 0.49-1.71). No significant differences were observed in secondary outcomes between the two groups. Subgroup analysis of infants<30 weeks yielded similar results.Although two-level CPAP theoretically offers benefits, BiPAP was not superior to nCPAP as initial support in preterm infants with RDS. This underscores the continued value of the simpler, well-established nCPAP and the need for multicentre trials involving preterm infants of varying gestational ages.
Gaucher disease is caused by mutations in the GBA1 gene, which encodes the β-glucocerebrosidase enzyme. The deficiency of this enzyme result in glucosylceramide and glucosylsphingosine accumulation, within lysosomes and...Gaucher disease is caused by mutations in the GBA1 gene, which encodes the β-glucocerebrosidase enzyme. The deficiency of this enzyme result in glucosylceramide and glucosylsphingosine accumulation, within lysosomes and resulted triggering inflammation and accumulating substrates affect multiple organ systems, causing progressive cellular damage. Evidence has shown that the accumulation of glucosylceramide in macrophages is associated with inflammatory processes, reactive oxygen species production and an imbalance between the pro-oxidants and the antioxidant reserve, resulting in oxidative stress and inflammation. The aim of this study was to compare the oxidative stress status between patients with Gaucher disease and healthy controls.Case-control study This study included 10 patients with Gaucher disease aged between 2-40 years, and 30 healthy controls. Total antioxidant capacity and total oxidant capacity parameters between these groups were compared. Although the total antioxidant capacity value of the case group was higher, it was not significant. The total oxidant capacity and oxidative stress index values were significantly higher in the patient group (p<0.05). Our study showed that oxidative stress increased in patients with Gaucher disease. The results of our study may guide the application of antioxidant treatment in Gaucher disease patients as a supportive treatment.
Primary ciliary dyskinesia is a rare genetic disease affecting ciliary motility and causing respiratory symptoms. Diagnosis can be done by high-speed-videomicroscopy using nasal epithelial cells (NECs) obtained via brush...Primary ciliary dyskinesia is a rare genetic disease affecting ciliary motility and causing respiratory symptoms. Diagnosis can be done by high-speed-videomicroscopy using nasal epithelial cells (NECs) obtained via brushings. This procedure can be painful, especially for children. The use of lidocaine is proposed to reduce this pain; however, it is not clear whether lidocaine changes ciliary beating frequency (CBF) or pattern (CBP) in the subsequent high-speed-videomicroscopy. The aim of this study was to analyse the effect of lidocaine on the CBF and the CBP of differentiated, air-liquid-interface cultured NECs.NECs from healthy volunteers were obtained via brushings and cultured at the air-liquid-interface. After differentiation, lidocaine or isotonic saline (IS, control) were added apically for 1 or 5 min each and CBF (in top view of whole inserts and side views of scratched cells) and CBP (only side view) were assessed and recorded up to 150 min. CBF was computed and CBP was analysed semiquantitatively.Lidocaine as well as IS increased the CBF in the top view approach significantly compared to baseline. However, we found no significant differences between lidocaine and IS (control) treatment. Additionally, no effect of lidocaine on CBF, CBP, amplitude, inter- and intracellular coordination or transport was seen in the side view approach.We conclude that the observed CBF increase is related to the addition of liquid on the mucus layer and not by the lidocaine itself. Therefore, it seems possible to use lidocaine for nasal analgesia without impact on subsequent analysis of the ciliary motility.