Penteli General Children's Hospital

Pediatric cholecystitis and cholelithiasis management is heterogeneous. We surveyed European centers to map current practices, training exposure, and outcomes of pediatric biliary cholecystectomy. A 24-item cross-sectional international survey was developed by the European Union of Medical Specialists (UEMS) Section of Paediatric Surgery and distributed to centers in 31 UEMS member states. Items covered institutional resources, indications and timing, surgical approach and adjuncts (ERCP, ICG), training exposure, and center-level outcomes; results are reported as n (%), median (IQR). Outcomes were reported at the center level and were self-reported by participating institutions. Thirty-two centers from 23/31 states responded (74.2%). Pediatric surgeons were primary operators in 84% (shared with adult surgeons in 16%); ERCP access was 66%. Trainee operator share was 22.5% (IQR 5-50) and simulator access 56%. ICG cholangiography was routine in 12.5% and selective in 31%. Acute calculous cholecystitis: 6% always index-admission and 59.4% interval (29-41 days) cholecystectomy; post-ERCP choledocholithiasis: 16% always index-admission cholecystectomy. In 2023, 185 cases were reported: 98.9% laparoscopic with 1.6% conversion; median age 14 years (IQR 12.25-15), operative time 90min (IQR 60-110), length of stay 2 days (IQR 1-2); 10 complications (5.4%). Substantial heterogeneity persists in both care pathways and training exposure; most centers lack formal pediatric-specific guidelines, and trainee-led operating remains limited, supporting the need for evidence-based protocols and structured training pathways.

<bold>BACKGROUND:</bold> SCSS are the cornerstone of effective treatment for many common pediatric respiratory conditions and are considered not to have systemic adverse effects. However, uncertainties remain, particularly as far as growth outcome and bone density are concerned. <bold>OBJECTIONS:</bold> The aim of this study was to record the use of SCSS since birth and to consistently follow the growth of otherwise healthy children until early adulthood. <bold>METHODS:</bold> 261 subjects(male 48.65%)were evaluated and were divided in 4 groups according to SCSS administration. Group A included cases that have never received systemic steroids. Group B consisted of patients that have been prescribed SCSS during infancy only(<3 years old). Group C consisted of cases that used SCSS during infancy and preschool years only, whereas Group D included children that used SCSS during infancy and up to adulthood. <bold>RESULTS:</bold> There was no difference among the different groups as far as age and sex are concerned. Boys reported twice as many days of SCSS use than girls and total days of therapy were negatively related to final height. No significant difference was detected for final height among boys or girls in groups A and B. However boys that belong to Group C and D were 4 and 5 cm shorter respectively, than boys in groups A and B. Both sexes than received SCSS during infancy were 1.7-2.5 cm, even non- significant, shorter than cases who never received. <bold>CONCLUSIONS:</bold> The use of SCSS merely during infancy had a minor impact on final height. Males with persistent use had significant lower final height and total days of treatment had an added inverse correlation. More studies are needed to clarify these results.

Previous reports have associated frailty with the existence of various chronic diseases. Especially for cardiovascular diseases, this relationship seems to be bidirectional as common pathophysiological mechanisms lead to the progression of both diseases and frailty. The study aimed to examine the relationship between chronic diseases and frailty in a sample of older Greek inpatients Methodology: In 457 consecutively admitted older patients (226, 49.5% females), the median age was 82 years (interquartile range [IQR] 75-89), and demographic factors, medical history, cause of admission, and the degree of frailty assessed with the Clinical Frailty Scale were recorded. The level of frailty was calculated for the pre-hospital status of the patients. Parametric tests and logistic regression analysis were applied to identify diseases independently associated with frailty. Using the scale, 277 patients (60.6%) were classified as frail and 180 as non-frail (39.4%). In univariate analysis, frail patients were more likely to have respiratory disease, dementia, Parkinson's disease, chronic kidney disease (CKD), atrial fibrillation (AFIB), neoplastic disease, depression, stroke, heart failure (HF), and coronary artery disease. In binomial regression analysis, the diseases that were statistically significantly associated with frailty were respiratory diseases (P= 0.009, odds ratio [OR] = 2.081, 95% confidence interval [CI] 1.198-3.615), dementia (P≤ 0.001, OR = 20.326, 95% CI 8.354-49.459), Parkinson's disease (P= 0.049, OR = 3.920, 95% CI 1.005-15.295), CKD (P= 0.018, OR = 2.542, 95% CI 1.172-5.512), AFIB (P= 0.017, OR = 1.863, 95% CI 1.118-3.103), HF (P= 0.002, OR = 2.411, 95% CI 1.389-4.185), and coronary artery disease (P= 0.004, OR = 2.434, 95% CI 1.324-4.475). Among diseases independently associated with frailty, chronic diseases such as respiratory diseases, dementia, Parkinson's disease, CKD, and cardiovascular diseases (AFIB, HF, and coronary heart disease) have an important role. Recognizing the diseases that are highly related to frailty may contribute, by their optimal management, to delaying the progression or even reversing frailty in a large proportion of the elderly.

This research ventures into the critical public health challenge of childhood obesity by exploring the dynamic interplay between psychological well-being and Body Mass Index (BMI) throughout various developmental stages of childhood. It delves into how emotional regulation, attachment dynamics, and social relationships correlate with obesity from early childhood to adolescence. Highlighting key findings, such as the negative correlation between psychological resilience and higher BMI in young children, the impact of social relationships on obesity risk during pre-adolescence, and the link between adaptive emotional strategies and higher BMI in adolescents, this study brings to the fore the nuanced relationship between psychological factors and obesity. Psychological metrics in this study were obtained via referenced questionnaires, leading up to the utilization of the interdisciplinary process of bioinformatics. Utilizing the interdisciplinary process of bioinformatics, this research synergizes psychometric and biomedical data to unearth psychological markers critical for crafting targeted, age-appropriate interventions. This study advocates for a holistic healthcare approach, emphasizing the integration of psychological support within obesity prevention and management strategies, thereby underscoring the indispensable role of psychological factors in the fight against childhood obesity. The application of bioinformatics methods to analyze complex datasets demonstrates how collaboration across medical specialties can enrich our understanding and response to childhood obesity, contributing significantly to the development of comprehensive, bioinformatics-enhanced healthcare solutions.

To summarize current knowledge of the literature on treatment of vestibular migraine. A review of the literature was conducted to collect all available published data on the treatment of vestibular migraine. The therapeutic approaches are based on case reports, retrospective cohort studies, and open-label trials from Medline search. Overall, 23 publications were related only to the specific treatment of vestibular migraine. Vestibular migraine remains still clinically under-diagnosed. Future studies are needed to understand the pathophysiological mechanisms and to introduce new effective therapies.

Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies.