Centro Hospitalar do Porto

Infectious thyroiditis is a rare condition, and it is more prevalent in children due to anatomical abnormalities. The main cause is the presence of a pyriform sinus fistula derived from the remnants of the third or fourth branchial arch. This article presents a case of a five-year-old boy with infectious thyroiditis complicated by a cervical abscess. Despite temporary improvement with oral antibiotics, the complaints recurred, and a new course of intravenous antibiotic therapy was necessary. A cervical ultrasound, MRI, and direct laryngoscopy were performed in order to diagnose an anatomical malformation. It was only during surgery that the existence of a fourth branchial arch fistula was observed, complicated by an infected prethyroidal cyst and proximity thyroiditis. After surgery, the patient was discharged and followed up in the pediatric endocrinology consultation, with particular attention to growth, intellectual development, thyroid function, and imaging. This case underscores the importance of thorough imaging of infectious thyroiditis to find out the underlying cause and its surgical resolution to prevent complications and ensure proper thyroid function.

The choice of vascular access (VA) plays a key role in the success of hemodialysis (HD). Despite their widespread use, central venous catheters (CVCs) are associated with higher rates of dysfunction, thrombosis, and catheter-related bloodstream infections (CRBSI). We investigated current practices in pediatric HD across European pediatric nephrology centers, focusing on VA choices, infection control measures, and CRBSI management. An online questionnaire was e-mailed to 119 members of the European Society for Pediatric Nephrology (ESPN) Dialysis Working Group and European Pediatric Dialysis Working Group (EPDWG). Descriptive statistics were used to summarize practices across centers, comparative analyses between centers in countries with Human Development Index (HDI) > 0.90 and < 0.90. Thirty-one centers across Europe participated in the survey. CVCs were the primary VA in 73.1% of the centers. Twenty (66.7%) centers reported malfunction as the most common CVC complication, followed by catheter thrombosis (19.4%) and CRBSI (12.9%). The diagnostic approach for CRBSI varied widely, with 35.4% of centers relying on a single positive catheter culture, while 57.9% did not collect a second culture from the peripheral vein or HD circuit. The most common empirical treatment was glycopeptides combined with third-generation cephalosporins. Nearly all centers used intravenous antibiotics for less than 3 weeks, and over half modified lock solutions with antibiotics following CRBSI diagnosis. Catheter removal practices were inconsistent, even in cases of severe infection. Centers reported a total of 548 HD patients. Exit-site infections and CRBSI were observed in 98 (17.8%) and 155 (28.2%) patients, respectively. CRBSI rates and CRBSI-related catheter replacements were significantly higher in centers from countries with HDI < 0.90 and in centers without a dedicated pediatric HD unit.Conclusion: The suboptimal adherence to current VA recommendations and wide variability in catheter care practices including the prevention, diagnosis, and management of CRBSI highlight the need for standardized pediatric-specific protocols to enhance catheter longevity and improve patient outcomes.What is Known:• Central venous catheters are widely used in pediatric hemodialysis but carry a high risk of complications, especially catheter-related bloodstream infections (CRBSI).What is New:• This multinational survey reveals significant variability in vascular access selection, CRBSI prevention, diagnosis, and treatment across European pediatric hemodialysis centers, with clear disparities by national HDI levels.• The findings highlight the need for standardization of vascular access care and CRBSI management and evidence-based pediatric-specific guidelines.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00431-025-06703-7.

Solid organ transplant (SOT) recipients face elevated tuberculosis risk, yet optimal prevention strategies in low- to medium-incidence regions remain unclear. We conducted a multicenter retrospective cohort study of adult SOT recipients transplanted between 2007 and2012 at 15 European centers, with follow-up through 2018. The primary outcome was microbiologically confirmed post-transplant tuberculosis. Incidence rates were calculated per 100,000 person-years; standardized incidence ratios (SIRs) used World Health Organization country-specific background rates. Cox models assessed risk factors. Among 5805 patients (median age 51; 62.7% male; 73.9% renal transplants), 33.8% were tested for tuberculosis infection and 10.3% received tuberculosis preventive therapy (TPT). Over 33,785 person-years, 23 patients (0.4%) developed tuberculosis (68.0/100,000 person-years). Highest incidence occurred in patients with positive screening but no TPT (233.8/100,000). Incidence was higher in Southern vs. Central Europe (251.9 vs. 28.7/100,000), with pooled SIRs of 12.8 and 3.1, respectively. Tuberculosis risk was elevated among Southern European recipients (HR 22.9) and those with migration history (HR 2.7). Tuberculosis risk is increased in European SOT recipients. Regionally adapted prevention strategies, including targeted screening in low-incidence areas and universal screening in higher-incidence regions, are warranted.

Social media has fundamentally altered how information is created, disseminated, and consumed, with growing impact on spine surgeons and professional societies. Traditional academic publishing remains the standard for research validation, but digital platforms now shape much of the real-time dialogue in spine care. To explore strategies for integrating spine surgeons' social media presence with traditional publishing channels to enhance knowledge dissemination, support clinical innovation, and improve member engagement within spine societies. This perspective reviews current patterns of social media use among spine surgeons, focusing on platforms such as X (formerly Twitter), Instagram, and LinkedIn. It analyzes benefits (reach, speed, interactivity) and challenges (variable quality, lack of peer review, potential bias), and proposes a conceptual hybrid model in which social media and peer-reviewed journals function in a complementary rather than competitive manner. Social media enables rapid sharing of clinical insights, techniques, and innovations, and facilitates engagement with both peers and patients. However, it often privileges observational data, lower-level evidence, and real-world experiences that do not easily fit into traditional high-level evidence frameworks. A hybrid approach is proposed in which professional societies (1) formally recognize curated social media content as a feeder for peer-reviewed work; (2) create more inclusive forums for lower-level evidence and case-based discussions; and (3) intentionally link digital dialogues to structured academic outputs. By aligning the dynamic, interactive nature of social media with the rigor and credibility of traditional publishing, spine societies can foster greater member engagement, accelerate innovation, and reinforce their role as thought leaders. A deliberate, hybrid communication strategy can bridge the gap between digital and print, creating a more collaborative and inclusive platform for advancing spine surgery. Integrating social media with traditional publishing can accelerate the dissemination of practical, real-world clinical insights, ultimately enhancing surgeon education and improving patient care in spine surgery.

Background Lipoprotein(a) (Lp(a)) is a plasma lipoprotein with atherogenic, prothrombotic, and proinflammatory properties. Elevated Lp(a) levels are linked to the development of early atherosclerosis in childhood and contribute to a higher risk of cardiovascular disease (CVD) in adulthood.Purpose This study aimed to assess the clinical significance of Lp(a) levels in Portuguese pediatric patients who underwent serum Lp(a) testing as part of a lipid disorder screening prompted by obesity, hypercholesterolemia, and/or a family history of premature CVD. We also evaluated the correlation between Lp(a) levels and CVD risk factors.Methods This cross-sectional retrospective study included 792 pediatric patients. Data on demographics, clinical history, body mass index, and laboratory values, including Lp(a), were collected. Lp(a) levels were categorized into 3 groups: <75 nmol/L, 75–125 nmol/L, and >125 nmol/L. A multivariate analysis was used to identify factors associated with Lp(a) ≥ 75 nmol/L.Results The most prevalent comorbidities in this sample were obesity and associated low-grade inflammation, each affecting at least one-third of participants. The median Lp(a) level was 31.80 nmol/L, with 9.1% and 21.6% of children having intermediate (75–125 nmol/L) and high (>125 nmol/L) Lp(a) levels, respectively. Higher total cholesterol, non–high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) levels were correlated with elevated Lp(a) levels. The multivariate analysis identified an elevated LDL-C level as a predictor of a higher Lp(a) level.Conclusion This study highlights the alarming prevalence of elevated Lp(a) levels in Portuguese pediatric patients who underwent serum Lp(a) testing due to lipid disorder screening, with >30% at intermediate/high CVD risk. As Lp(a) levels are mostly genetically determined and tend to persist into adulthood, these findings emphasize the importance of including Lp(a) screening in the cardiovascular risk assessment of children with CVD risk factors to enable timely prevention strategies for adultonset CVD.

Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases. We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ⩽5. The primary outcome measure, END, was defined as a shift of ⩾4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END. Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (adjusted odds ratio [aOR] 2.37, 95% CI 1.12-5.02, p = 0.02), while intravenous thrombolysis (IVT) was associated with lower odds of END (aOR 0.46, 95% CI 0.26-0.81, p = 0.008). However, the association between MT and END was no longer statistically significant in the IPTW-adjusted analysis (OR 1.65, 95% CI 0.69-3.98, p = 0.26). Hypertension and antiplatelet use at baseline were also independently associated with END. Among MT-treated patients, successful and excellent recanalization and first-pass effect were protective against END. MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.