Pediatric venous thromboembolism in relation to adults

ObjectiveThis review was performed to analyze the current knowledge and controversies in the pathophysiology, diagnosis, treatment, and outcomes of pediatric venous thromboembolism (VTE) compared with adults.MethodsSearches of the MEDLINE database and manual searches of the references of selected articles were performed to select reports for their relevance and quality of information on the similarities and differences in pathophysiology, diagnosis, and treatment of VTE in children and adults.ResultsSymptomatic VTE incidence is reported at a rate of 0.07 in every 10,000 children, which is significantly lower than the rate in adults. Pulmonary emboli in adolescents are rarely fatal, unlike in adults. VTE recurrence is also much lower in children. Young age has been shown to be protective of VTE, whereas central venous catheters are very important in pediatric venous thrombosis. The incidence of postthrombotic syndrome varies from 20% to 65%, with mild symptoms in most children. Cerebral and visceral vein thrombosis may lead to severe morbidity and death. Some factors of thrombophilia have a significant effect in the pediatric population; however, its overall significance is controversial. Most data on VTE treatment are extrapolated from studies in adults. Children with acute VTE should be treated with anticoagulation therapy. Treatment duration depends on the nature of the thrombosis and previous VTE events.ConclusionsThere is a paucity of prospective randomized studies with data determining not only the effect of VTE but also the treatment options in children. Thrombophilia is a risk factor for pediatric VTE, but its significance has not been thoroughly investigated. Guidelines specific to children for antithrombotic therapy, prophylaxis, and optimal duration need re-evaluation and support by strong evidence

Celtic pilgrimage, past and present: from historical geography to contemporary embodied practices

Perigrinatio, the Latin term for pilgrimage was at the heart of the medieval Celtic church, but was this was understood and practised not only as a journey to a shrine, but more broadly as a spiritual journey, which could lead to an isolated hermitage or peripatetic evangelistic mission. In this paper, we outline the beliefs and practices of the broad assemblage known as the Celtic church, particularly the interleaving of pilgrimage, asceticism and landscape poetics, and how these have informed continued and renewed pilgrimage practices to sites of the early Celtic church by particular denominations, ecumenical groups and those interested in broader spiritualities. These sacred mobilities are explored through vignettes of embodied-emotionalspiritual practices situated in the landscapes and faith communities of Lough Derg,Ireland and the Isle of Man. They share geographical marginality, a focus on multiple Celtic saints and an enduring belief in the immanence of God, expressed through embodied spiritual practice in the landscape. However, they differ widely in matters of institutionalised structure, regulation, discursive scripting and gendered hierarchy, reflecting situated and denominational preferences for the ascetic and aesthetic spiritual legacies of the medieval Celtic church

Report Card grades on the physical activity of children and youth comparing 30 very high Human Development Index countries

Background: To better understand the childhood physical inactivity crisis, Report Cards on physical activity of children and youth were prepared concurrently in 30 very high Human Development Index countries. The aim of this article was to present, describe, and compare the findings from these Report Cards. Methods: The Report Cards were developed using a harmonized process for data gathering, assessing, and assigning grades to 10 common physical activity indicators. Descriptive statistics were calculated after converting letter grades to interval variables, and correlational analyses between the 10 common indicators were performed using Spearman's rank correlation coefficients. Results: A matrix of 300 grades was obtained with substantial variations within and between countries. Low grades were observed for behavioral indicators, and higher grades were observed for sources of influence indicators, indicating a disconnect between supports and desired behaviors. Conclusion: This analysis summarizes the level and context of the physical activity of children and youth among very high Human Development Index countries, and provides additional evidence that the situation regarding physical activity in children and youth is very concerning. Unless a major shift to a more active lifestyle happens soon, a high rate of noncommunicable diseases can be anticipated when this generation of children reaches adulthood.</p

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Supernumerary ovary presenting as a paraduodenal duplication cyst

Supernumerary ovary is a rare gynecological anomaly and is generally excised due to its potential malignant transformation. We report a case of a patient who was referred for excision of a probable duodenal duplication cyst that was subsequently identified as a paraduodenal supernumerary ovary. Pediatric surgery was consulted on an adolescent patient due to a presumed congenital anomaly of the intestinal tract based on imaging studies

Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked

Acquired diaphragmatic hernias are a rare occurrence. They can result from blunt, penetrating or inadvertent iatrogenic injury. When overlooked they can potentially be catastrophic. We report a case of iatrogenic diaphragmatic hernia in a six-month old infant presenting with acute respiratory distress as a result of strangulated bowel herniating into the left hemithorax caused from a traumatic chest tube insertion in the neonatal period

Three-membered Rings with Two Heteroatoms including Phosphorus to Bismuth

Weber L. Three-membered Rings with Two Heteroatoms including Phosphorus to Bismuth. In: Katrizky AR, Ramsden CA, Scriven EFV, Taylor RJK, eds. Comprehensive Heterocyclic Chemistry III : a Review of the Literature 1995-2007. Vol. 1. Oxford: Elsevier; 2008: 695-747.The chapter describes the synthesis, structures, bonding, and chemical properties of three-membered ings with two heteroatoms including phosphorus, arsenic, and antimony. Covering the literature of the years between 1996 to 2006 diphosphiranes, diphosphirenes, diphosphirenium- and diphosphirenylium complexes, phosphaarsiranes and phosphastibiranes are discussed. Structural features are elucidated by NMR-data, single crystal X-ray investigations and quantum chemical studies. Thereby the great difference in organonitrogen and organophosphorus chemistry became evident as pointed out in the case of bisphosphino carbenium- and amidinium-ions. Moreover, diphosphirenyl radicals and dimers thereof are without precedence in organonitrogen chemistry. The progress in the chemistry under discussion is to some extend due to the availability of novel appropriately functionalized phosphaalkenes and phosphaalkynes

Reconsidering Diagnosis, Treatment, and Postoperative Care in Children with Cloacal Malformations

Cloacal malformations are among the most complex types of anorectal malformation and are characterized by the urological, genital, and intestinal tracts opening through a single common channel in the perineum. Long-term outcome is affected by multiple factors, which include anatomical variants of the malformation itself, associated anomalies, and the surgical approach. Reconsidering these variables and their influence on “patient important” function might lead to strategies that are more outcome-driven than focused on the creation of normal anatomy. Key outcomes reflect function in each of the involved tracts and the follow-up needed should therefore not only include the classical fields of colorectal surgery and urology but also focus on items such as gynecology, sexuality, family-building, and quality of life as well as other psychological aspects. Involving patients and families in determining optimal treatment strategies and outcome measures could lead to improved outcomes for the individual patient. A strategy to support delivery of personalized care for patients with cloacal malformations by aiming to define the best functional outcomes achievable for any individual, then select the treatment pathway most likely deliver that, with the minimum morbidity and cost, would be attractive. Combining the current therapies with ongoing technological advances such as tissue expansion might be a way to achieve this