Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis : A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network

While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.Peer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

EVALUATION OF PATIENTS WITH PRIMARY HYPEROXALURIA TYPE 1: A MULTICENTER STUDY

WOS: 000443998400363

Predictors of poor kidney outcome in children with C3 glomerulopathy

Background C3 glomerulopathy (C3G) is characterized by heterogeneous clinical presentation, outcome, and predominant C3 accumulation in glomeruli without significant IgG. There is scarce outcome data regarding childhood C3G. We describe clinical and pathological features, treatment and outcomes, and risk factors for progression to chronic kidney disease stage 5 (CKD5) in the largest pediatric series with biopsy-proven C3G

Editor-in-Chief

Andrejs Geske (University of Latvia, Latvia) B. N. Ghosh (Eastern Med. Univ. North Cyprus) Bayram Ürekli (University of Selçuk, Türkiye) Erdinç Didar (American University, Bulgaria) Ercan Tatlıdil (University of Ege, Türkiye) Erman Artun (University of Çukurova, Türkiye) Hikmet Y. Celkan (University of Gaziantep, Türkiye) Hüseyin Bağcı (METU, Türkiye) Jean Crombois (American University, Bulgaria) Kemal Silay (Indiana University, USA) Lelio Iapadre (University of L'Aquila, Italy) Michael Goldman (University of Minnesota, USA

Influence of Surface Finish on Flexural Strength and Microhardness of Indirect Resin Composites and the Effect of Thermal Cycling

This study investigated the effect of surface finish and thermal cycling procedures on flexural strength and surface microhardness of three indirect resin composites, Artglass (R), Signum (R), and Solidex (R). The specimens were prepared in sufficient number and size according to flexural and microhardness test requirements (n=10). Scanning electron microscopy-energy dispersive x-ray (SEM-EDX) analysis was also used for studying the morphology, dispersion, and elemental compositions of fillers. The EDX results showed that Artglass contained 1.57% aluminium oxide (Al2O3), 53.29% silicon dioxide (SiO2), and 2.62% barium oxide (BaO); Signum had 55.69% silicon dioxide (SiO2) and Solidex had 44.99% silicon dioxide (SiO2) of total mass. Artglass appeared to display the best flexural strength values under all the test conditions employed (range: 116.8 +/- 32.18 to 147.8 +/- 47.97 MPa), and it was followed by Signum (range: 93.7 +/- 22.84 to 118.0 +/- 33.45 MPa). Thermal cycling did not seem to have affected the flexural strength of Artglass and Signum (p > 0.05); however, it led to a significant decrease, from (110.5 +/- 20.69 MPa) to 74.0 +/- 13.30 MPa (p < 0.001), in the strength of polished Solidex specimens. While surface microhardness of the three materials increased by polishing ( Artglass: 55.7 +/- 2.64/74.1 +/- 8.63 Vickers Hardness Numbers (VHN); Signum: 44.8 +/- 3.12/60.7 +/- 4.50 VHN; Solidex: 44.0 +/- 2.31/53.4 +/- 3.58 VHN for unpolished/polpolished specimens), thermal cycling had a deleterious effect on this property (p < 0.001)

Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis: A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network.

While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children