Notes

KLF6 Promotes Pyroptosis of Renal Tubular Epithelial Tissues throughout Septic Acute Renal system Damage.
Autoimmune hemolytic anemia (AIHA) is a rare and generally self-limiting disease in children.

A descriptive cross-sectional study was performed in children under 18 years diagnosed with AIHA from January/1997 to July/2019. Clinical variables were collected and AIHA was classified according to the direct antiglobulin test (DAT) in warm AIHA (IgG+/-C3d) and cold AIHA (C3d). Response to treatment and evolution were analyzed.

25 patients were included and 72% were males. The median age at diagnosis was 2 years (range 0.4 to 9). Fever (72%), pallor (68%), jaundice (64%), hepatosplenomegaly and coluria (48%) were the most common presenting symptoms. The median hemoglobin at diagnosis was 5.4 g/dl. DAT was positive in 96%, with detection of IgG antibodies in 76%. A single case presented negative DAT. 20% of the patients associated another cytopenia, one of which was subsequently diagnosed with common variable immunodeficiency. Concomitant viral infection was suspected or documented in 32%. Most of the cases were self-limiting and responded to corticosteroid treatment (72%). Those with partial response (24%), mainly those associated with other cytopenias, required other lines of treatment (rituximab, mycophenolate, immunoglobulins). Complications (32%) and relapses (26%) were detected only in warm AIHA.

Our case series confirms that AIHA is a very rare disease in childhood. Most cases evolve favorably, although up to a quarter of them require second lines of treatment and, in exceptional cases, they need very aggressive treatments. These latter cases generally correspond to patients who present more than one cytopenia in the course of the disease.
Our case series confirms that AIHA is a very rare disease in childhood. Most cases evolve favorably, although up to a quarter of them require second lines of treatment and, in exceptional cases, they need very aggressive treatments. These latter cases generally correspond to patients who present more than one cytopenia in the course of the disease.
The number of patients with complex chronic conditions (CCC) has increased in the last 20 years or so. There is limited data as regards the prevalence of CCC in the paediatric population and its impact on hospital admissions. The main objectives of this study are to determine the proportion of CCC in the paediatric hospital population and compare them with other groups of patients admitted (acute and chronic).

A descriptive, retrospective study was carried out in a tertiary maternity-paediatric hospital (from December 2016 to November 2017). All patients admitted into the Paediatric Department were recruited with a fortnightly frequency. A series of demographic, clinical, and pregnancy data were collected. In order to identify the level of complexity of the patients, the Clinical Risk Group (CRG) was used, with 3groups being created acute, chronic, and CCC. Statistics analysis was performed using SPSS v24.

A total of 1,433 patients were included. The proportion of CCC on the Paediatric Ward was 14.4%. The CCC were older patients, mainly admitted due to decompensation or progression of their underlying disease, had a longer admission time, and required support in the Paediatric Intensive Care Unit more often than that of the other sub-groups. Just under half (44.7%) of the CCC were carriers of a technological device. Of the total of long stays (>1 month), 71.3% had CCC.

Patients with CCC require long hospital stays, a greater need of intensive care, and use of technology. #link# New approaches to treatment and follow-up need to be established. They should be cost-effective, and at the same time decrease the impact of the disease on the children and their family.
Patients with CCC require long hospital stays, a greater need of intensive care, and use of technology. New approaches to treatment and follow-up need to be established. They should be cost-effective, and at the same time decrease the impact of the disease on the children and their family.Obstructive sleep apnoea (OSA) is a very common disease with a prevalence that ranges from 1% to 6% in children. It is characterized by intermittent partial or complete occlusion of the upper airway during sleep, leading to recurrent arousals and disturbed sleep architecture, to neurocognitive disorders and alterations in homeostatic gas exchange. Cardiovascular complications may develop in children with OSA through various mechanisms including activation and dysregulation of the sympathetic nervous system, induction of pro-inflammatory and pro-oxidant status and increased risk of systemic hypertension. link2 As the deleterious effects of OSA on the cardio-vascular system may start early in life, in this brief review we focused our attention both on early and late cardiological changes induced by apnoeic events in the paediatric population, by reviewing recent findings in the literature.
to assess the epidemiology and features of de novo surgical diseases in patients admitted with COVID-19, and their impact on patients and healthcare system.

Gastrointestinal involvement has been described in COVID-19; however, no clear figures of incidence, epidemiology and economic impact exist for de-novo surgical diseases in hospitalized patients.

This is a prospective study including all patients admitted with confirmed SARS-CoV-2 rT-PCR, between 1 March and 15 May 2020at two Tertiary Hospitals. Patients with known surgical disease at admission were excluded. Sub-analyses were performed with a consecutive group of COVID-19 patients admitted during the study period, who did not require surgical consultation.

Ten out of 3089 COVID-19 positive patients (0.32%) required surgical consultation. Among those admitted in intensive care unit (ICU) incidence was 1.9%. Mortality was 40% in patients requiring immediate surgery and 20% in those suitable for conservative management. The overall median length of stay (LOS) of patients admitted to ICU was longer in those requiring surgical consultation compared with those who did not (51.5 vs 25 days, p=0.0042). Patients requiring surgical consultation and treatment for de-novo surgical disease had longer median ICU-LOS (31.5 vs 12 days, p=0.0004). A median of two post-surgical complications were registered for each patient undergoing surgery. Complication-associated costs were as high as 38,962 USD per patient.

Incidence of de-novo surgical diseases is low in COVID-19, but it is associated with significant morbidity and mortality. Future studies should elucidate the mechanism underlying the condition and identify strategies to prevent the need for surgery.
Incidence of de-novo surgical diseases is low in COVID-19, but it is associated with significant morbidity and mortality. Future studies should elucidate the mechanism underlying the condition and identify strategies to prevent the need for surgery.
As the transgender and gender non-conforming (TGNC) population in the United States continues to grow, there is a need for health care providers who are competent in managing gender-affirming therapy (GAT) for these individuals.

The purpose of this study was to assess practicing pharmacists' readiness to care for transgender and gender nonconforming (TGNC) patients and to compare the perceptions between pharmacists who have received formal education about gender-affirming therapy (GAT) and those who have not received such training.

This was a cross-sectional study that was conducted online over 4 weeks (January 2019-February 2019). A survey was distributed to pharmacists in the United States. UNC2250 of the survey was conducted through professional pharmacy social media groups. Respondents were asked to anonymously rate their perceived preparedness to care for a TGNC patient and to disclose any formal GAT training they had received during pharmacy school or through continuing pharmacy education. Reide care for and interact with transgender patients.
Increased accessibility to GAT education for pharmacists may be associated with a significant growth in pharmacists' perceived ability to provide care for and interact with transgender patients.
With the rapid development of computed tomography (CT) scanners, the assessment of the radiation dose received by the patient has become a heavily researched topic and may result in a reduction in radiation exposure risk. In this study, radiation doses were measured using three paediatric phantoms for head and chest CT examinations in Najran, Saudi Arabia.

Thirteen scanners were included in the study to estimate the CT radiation doses using three phantoms representing three age groups (1-, 5-, and 10-year-old patients).

The volume CT dose index (CTDI
) estimated for each phantom ranged from 6.56 to 41.12mGy and 0.292 to 11.10mGy for the head and chest examinations, respectively. The estimation of lifetime attributable risk (LAR) indicated that the cancer risk could reach approximately 0.02-0.16% per 500 children undergoing head and chest CT examinations.

The comparison with the published data of the European Commission (EC) and countries reported in this study revealed that the mean CTDI
for the head examinations was within the recommended dose reference levels (DRLs). Meanwhile, chest results exceeded the international DRLs for the one-year-old phantoms, suggesting that optimisation work is required at a number of sites.

The variation among CT doses reported in this study showed that substantial standardisation is needed.
The variation among CT doses reported in this study showed that substantial standardisation is needed.
Transient tachypnea of the newborn (TTN), which is diagnosed using typical clinical course and radiographic findings, is the most common cause of respiratory distress in late-preterm and term neonates. Lung ultrasound (LUS) is increasingly used to identify TTN according to the distinct characteristics of the disease. However, few studies have reported the application of LUS to monitor the clinical evolution of TTN. link3 Using serial LUS, this prospective study assessed and monitored TTN severity.

From November 2018 to October 2019, neonates ≥34 weeks of gestation admitted to the newborn center of Chang Gung Memorial Hospital were enrolled. Neonates diagnosed with TTN and requiring respiratory support comprised the TTN group (n=29), whereas those without respiratory disease served as the control group (n=23). LUS was performed and scored in both groups within 4h of admission and followed up at 24 and 48h.

A total of 65 infants were screened for enrollment and 13 were excluded. Most of the enrollees in both groups exhibited a peak LUS score on the first day, which then gradually declined thereafter. In comparison with the control group, the LUS score of the TTN group was higher on day 1 and day 2, and it had a significantly greater decrease from day 1 to day 2. In the TTN group, LUS scores moderately correlated with respiratory severity scores.

We conducted a serial and quantitative LUS investigation in late-preterm and term infants with TTN. The LUS score mirrored the respiratory status relatively well, and it can help to monitor the clinical course of TTN, in the case of either resolution or deterioration.
We conducted a serial and quantitative LUS investigation in late-preterm and term infants with TTN. The LUS score mirrored the respiratory status relatively well, and it can help to monitor the clinical course of TTN, in the case of either resolution or deterioration.
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