Search Results (3,788)

Background: Cardiac arrhythmias in children and adolescents may present with nonspecific symptoms such as precordial pain, palpitations, and syncope. We evaluated the clinical characteristics and rhythm findings of symptomatic pediatric patients and examined cross-sectional associations between reported symptoms and selected rhythm diagnoses, with particular attention to the diagnostic and management yield of ambulatory Holter monitoring. Because symptom timing is not always captured during diagnostic monitoring, associations between reported symptoms and detected rhythm abnormalities must be distinguished from temporal symptom–rhythm correlation and causation. Methods: We conducted an observational study of 119 children and adolescents aged 1–18 years, who were evaluated at a tertiary pediatric hospital for symptoms potentially suggestive of cardiac rhythm abnormalities. Data included demographic characteristics, clinical symptoms, personal and family history, resting electrocardiography, ambulatory Holter monitoring, and exercise testing where clinically indicated. The primary analysis was cross-sectional. Because symptom timing during ambulatory monitoring was not recorded, the study was not designed to establish temporal symptom–rhythm correlation or causality. Descriptive analyses were performed for the final 119-participant cohort. Selected symptom–rhythm associations were evaluated using the contingency table methods with odds ratios (ORs), 95% confidence intervals (CIs), and Fisher’s exact tests where appropriate. Holm’s adjustment was applied to the prespecified family of reconstructed symptom–rhythm comparisons. Results were interpreted according to both statistical evidence and effect-size precision. Results: The cohort comprised 119 participants, including 75 females (63.0%) and 44 males (37.0%). The most frequently reported symptoms were precordial pain (105/119, 88.2%), palpitations (80/119, 67.2%), and syncope or lipothymia (39/119, 32.8%). A family history of sudden cardiac death was reported by 28 participants (23.5%). Forty-two participants (35.3%) had a normal resting ECG, while 77 (64.7%) underwent ambulatory Holter monitoring. Among those undergoing Holter monitoring, 65/77 (84.4%) had rhythm abnormalities detected exclusively by ambulatory monitoring and not identified on the resting ECG. Holter findings resulted in at least one documented management change in 38/77 participants (49.4%). Management categories were not mutually exclusive and included lifestyle or activity adjustment in 21 participants, initiation of antiarrhythmic therapy in 19, medication monitoring in 19, and targeted cardiac imaging, including cardiac magnetic resonance imaging, in 5. In this cross-sectional analysis, reported syncope/lipothymia was strongly associated with the presence of complete atrioventricular block (10/39 [25.6%] versus 1/80 [1.3%]; OR 27.24, 95% CI 3.34–222.29; Fisher’s exact p < 0.001; Holm’s adjusted p approximately 0.0004). The unadjusted association between syncope/lipothymia and the WPW-labelled diagnosis did not remain statistically significant after Holm’s adjustment. No statistically significant associations were identified between syncope/lipothymia and PSVT or VT. Conclusions: In this pediatric cohort, ambulatory Holter monitoring identified rhythm abnormalities not detected on resting ECG in a substantial proportion of monitored participants and resulted in documented changes in clinical management in approximately half of those monitored. Reported syncope/lipothymia was strongly associated with the presence of complete atrioventricular block in the reconstructed cross-sectional analysis. Because symptom timing during monitoring was not recorded, these findings do not establish that the detected rhythm abnormalities caused the reported symptoms or that symptoms predict future rhythm outcomes. Further studies using prospectively defined symptom–rhythm event recording and longitudinal follow-up are needed to evaluate temporal correlation and prognosis. Full article

Background/Objectives: Pediatric acute pancreatitis (AP) is increasingly recognized as a clinically significant disease, yet Central and Eastern European cohort data remain limited. Acute recurrent pancreatitis (ARP) affects a substantial proportion of these children and may reflect distinct underlying etiologies. This study aimed to characterize the etiological spectrum, disease severity, and hospitalization outcomes of AP and ARP in a pediatric tertiary referral population, and to identify early clinical predictors of severity. Methods: We retrospectively analyzed 63 children hospitalized between 2018 and 2025 with 77 documented episodes of AP. Diagnosis followed INSPPIRE criteria, and severity was graded using the 2017 NASPGHAN classification. Etiologies, clinical presentation, laboratory parameters, imaging findings, and hospitalization length were compared between AP and ARP groups, across severity and etiological complexity categories using appropriate non-parametric and permutation-based methods. Results: Genetic etiologies predominated in ARP (37.0%), whereas idiopathic and infectious causes were more common in first-episode AP (24.0% and 14.0%, respectively; overall p < 0.001). Severity distribution did not differ between AP and ARP, with mild disease accounting for the majority of episodes in both groups. Serum albumin was significantly lower in moderate/severe episodes (p = 0.030). Within the single-episode subgroup, etiological complexity emerged as a significant predictor of prolonged hospitalization, with complex multifactorial or systemic etiologies associated with markedly longer stays than idiopathic or single-factor disease (Welch ANOVA p = 0.007). Conclusions: In this Romanian pediatric cohort, genetic causes dominate ARP, while idiopathic and infectious etiologies characterize first-episode AP, supporting a stepwise approach in which comprehensive etiological work-up, including genetic testing, is prioritized after recurrence. The predominance of genetic causes in ARP should be interpreted with caution, as genetic testing was applied selectively, predominantly after recurrence. Recurrence status alone does not predict severity, whereas etiological complexity at first presentation and hypoalbuminemia represent practical, accessible early markers for clinically assessing more severe disease. Full article

Background/Objectives: Severe dengue and dengue–malaria coinfection represent major diagnostic and therapeutic challenges in tropical endemic settings, where overlapping clinical manifestations may delay recognition of deterioration. This study aimed to describe the clinical and epidemiological characteristics of patients with severe dengue, dengue with warning signs, and dengue–malaria coinfection treated at a referral hospital in Montería, Córdoba, Colombia. Methods: A retrospective case series was conducted by reviewing medical records of patients diagnosed with dengue between 2018 and 2023. Cases classified as dengue without warning signs were excluded. The final analysis included patients with dengue-warning signs, severe dengue, and dengue–malaria coinfection. Dengue classification followed the 2009 World Health Organization criteria, and malaria was confirmed by thick blood smear. Sociodemographic, clinical, laboratory, geographic, and outcome-related variables were collected. Descriptive analyses were performed, and selected categorical variables were compared using Fisher’s exact test. Results: Fifty-three patients were included: 25 (47.17%) with severe dengue, 14 (26.42%) with dengue with warning signs, and 14 (26.42%) with dengue–malaria coinfection. Severe dengue was more frequent among females, whereas dengue with warning signs and coinfection predominated in males. Children accounted for the highest proportion of severe dengue cases, while coinfected cases were mainly distributed between childhood and adolescence. Fever was documented in all patients. Edema, elevated hematocrit, severe plasma leakage, and hemodynamic compromise were more frequent among severe dengue cases, whereas myalgia differed significantly across clinical groups. Ten deaths were recorded, six occurring in coinfected patients. Conclusions: Severe dengue and dengue–malaria coinfection are clinically complex conditions with overlapping manifestations and potentially fatal outcomes, highlighting the need for early recognition, differential diagnosis, and close monitoring. Full article

Background/Objectives: Scoliosis in children leads to complex physical, psychosocial, and functional impairments, yet evidence from low-resource settings is limited. To evaluate health-related quality of life (HRQoL) in Ethiopian children with scoliosis using WHODAS 2.0 and EQ-5D-Y, and to identify clinical and demographic correlates of disability. Methods: A hospital-based cross-sectional study was conducted at CURE Children’s Hospital of Ethiopia (1 April 2024–31 March 2025). Ninety-seven children aged 6–15 years with confirmed scoliosis were assessed. WHODAS 2.0 (36-item) captured disability across six domains, while EQ-5D-Y measured physical, psychosocial, and pain-related HRQoL. Clinical severity indicators (Cobb angle, trunk rotation, thoracic morphometrics, anthropometrics) were recorded. Analyses in Python 3.12 included descriptive statistics, correlation, and multiple regression to examine associations between scoliosis severity and HRQoL outcomes. Results: Ninety-seven Ethiopian children diagnosed with scoliosis (mean age 11.4 years, mean Cobb angle 73.5°) were assessed; congenital scoliosis was most common (45.4%), followed by idiopathic (38.1%) and neuromuscular (16.5%). WHODAS 2.0 revealed substantial disability, particularly in mobility (46.4%) and social participation (62.8%), with life activities and participation as the strongest contributors. Greater deformity, younger age, and smaller body size were linked to worse outcomes, with neuromuscular and very severe thoracolumbar cases most affected. EQ-5D-Y showed marked HRQoL impairments across domains, with psychological distress (mean 2.24/3), pain, and self-care limitations emerging as key burdens. The mean EQ score was 8.89/15 (59.2%), indicating reduced quality of life. Regression analyses highlighted pain, psychological distress, and self-care limitations as the domains most strongly associated with poorer HRQoL, while greater Cobb angle and higher ATR degree were also correlated with reduced quality of life. Conclusions: Ethiopian children with scoliosis experience significant multidimensional impairments in HRQoL, with mobility, social participation, pain, and psychological distress as dominant burdens. WHODAS 2.0 and EQ-5D-Y proved complementary in capturing these impacts, supporting their use for early detection, clinical care, and public health planning in resource-limited settings. Full article

Background/Objective: Vaccination is one of the most effective and cost-effective preventive health measures for preventing infectious diseases. The literature reports that children with chronic illnesses have lower vaccination rates than healthy children and are at higher risk for preventable diseases. This study aimed to determine the immunization status of children with chronic illnesses, assess vaccination rates, and help raise awareness on this issue. Material/Method: Children aged 1 month to 18 years who presented to or were admitted to the Pediatric Clinic of Mersin City Education and Research Hospital between 1 March and 30 June 2024, and who were followed up for their chronic illness, and whose parents gave their consent, were included in the study. Sociodemographic data and information about routine and vaccines outside the national immunization schedule (Rotavirus, meningococcal, HPV, Influenza) were obtained from the parents. The status of vaccination of disease-specific recommended vaccines was also recorded. Results: A total of 256 children were included in the study (mean age 8.7 ± 4.69 years; 42.2% girls). A high rate of complete vaccination according to the routine vaccination schedule was observed. However, non-routine vaccinations were administered at low rates: rotavirus 9%, meningococcal 4.7%, and influenza 12.2%. The HPV vaccine was administered to only one patient in the study group. Recommended vaccines for the disease were administered to only 16.4% of eligible children. Conclusions: Children with chronic illnesses are at high risk for infection and complications. Increasing vaccine awareness among both healthcare professionals and parents will contribute to higher immunization rates. Comprehensive studies are needed to identify factors influencing vaccination in this population. Full article

Purpose: Extubation timing after paediatric cardiac catheterisation under general anaesthesia remains a challenging clinical decision, particularly in children with cyanotic or haemodynamically significant congenital heart disease. This study aimed to evaluate factors associated with non-on-table extubation and to assess early postoperative respiratory outcomes in this high-risk population. Design: This was a single-centre retrospective cohort study conducted in a paediatric cardiac catheterisation laboratory. Methods: Paediatric patients with cyanotic or haemodynamically significant/complex congenital heart disease who underwent cardiac catheterisation under general anaesthesia with endotracheal intubation were included. Patients were grouped according to whether they were extubated on-table in the catheterisation laboratory or transferred to the intensive care unit with ongoing invasive mechanical ventilation. The primary outcome was non-on-table extubation. Secondary outcomes included extubation timing, reintubation within 48 h, major respiratory complications within 48 h, intensive care unit length of stay, hospital length of stay, and 7-day and 30-day mortality. Logistic regression analysis was used to identify factors associated with non-on-table extubation. Findings: Seventy-two patients were included. On-table extubation was performed in 52 patients (72.2%), whereas 20 patients (27.8%) were not extubated on-table. Patients not extubated on-table were younger, had lower body weight, higher American Society of Anesthesiologists physical status IV (ASA IV) frequency, higher Catheterization Risk Score for Pediatrics (CRISP) scores, lower baseline SpO₂, and were more frequently undergoing emergency procedures. Reintubation within 48 h occurred only in the non-on-table extubation group (15.0% vs. 0.0%; p = 0.019). Major respiratory complications within 48 h were more frequent in patients not extubated on-table (20.0% vs. 3.8%; p = 0.047). Intensive care unit and hospital length of stay were also longer in this group. In multivariable analysis, higher CRISP score (adjusted odds ratio 1.22; 95% confidence interval 1.009–1.476; p = 0.040) and emergency procedure (adjusted odds ratio 8.74; 95% confidence interval 1.365–55.927; p = 0.022) were independently associated with non-on-table extubation. No 7-day mortality occurred in either group. Conclusions: On-table extubation after paediatric cardiac catheterisation under general anaesthesia was feasible in most selected patients with cyanotic or haemodynamically significant/complex congenital heart disease. Higher CRISP score and emergency procedures were independently associated with non-on-table extubation. These findings suggest that catheterisation-specific risk assessment may help anticipate postoperative ventilatory requirements in high-risk paediatric cardiac catheterisation patients. Full article

Background/Objectives: The objective of this study is to evaluate the efficacy and safety of maintaining antimicrobial (AM) therapy or adjusting AM therapy during episodes of febrile neutropenia (FN) catalogued as a fever of unknown origin (FUO) in children with cancer. Methods: This is a prospective, multicenter, noninferiority, randomized study, approved by ethics committee, in children with episodes of FN in eight hospitals in Chile. Microbiological and molecular samples were drawn at admission. Patients with FUO (negative bacterial and viral study with no clinical focus suggesting infection) and favorable evolution during the first 48–72 h of AM therapy were randomized 1:1 to maintain or adjust treatment, reducing the number and spectrum of AMs. The primary endpoint was the percentage of episodes with an uneventful resolution; the secondary endpoints were the re-adjustment of AM therapy, days of fever/hospitalization/AM therapy, days of vancomycin and meropenem per 1000 days of neutropenia, number of AMs after randomization, pediatric intensive care unit (PICU) admission, sepsis, and death. Results: A total of 266 of 939 FN episodes recruited between March 2021 and January 2024 were catalogued as FUO, of which 231 had a favorable evolution at 48–72 h and were randomized, 111 to maintain and 120 to adjust AM therapy. Both groups presented the same percentage of uneventful resolution, with 106 (96%) in the group that maintain AM therapy and 114 (95%) in the adjusted group (p = 1.00); relative risk 1.01, (95%CI 0.95–1.06); absolute risk difference 0.01, (95%CI −0.05–0.06). Conclusions: The main finding of this study demonstrates that adjusting antimicrobial therapy appears safe in carefully selected FUO cases with a favorable early evolution, during episodes of FN catalogued as FUO in children with cancer. These findings open an opportunity to new AM stewardship strategies in this population, with a possible future impact on AM resistance. Full article

Background/Objectives: Although SARS-CoV-2 infection is usually mild in children, some develop severe respiratory disease (RD) or multisystem inflammatory syndrome in children (MIS-C). We evaluated long-term respiratory symptoms, pulmonary function, and cardiopulmonary exercise performance in children recovering from SARS-CoV-2-related RD and MIS-C. Methods: This single-center prospective observational study included children hospitalized for SARS-CoV-2-related RD or MIS-C. Pulmonary function tests (PFTs) and cardiopulmonary exercise testing (CPET) were performed at a mean follow-up of 22.8 ± 9.8 months after hospitalization and compared between groups. Results: Forty-two children (25 RD, 17 MIS-C) were included. Persistent post-COVID symptoms were reported by 38.1% of participants and were more frequent in the RD group (56.0% vs. 11.8%; p < 0.01), with fatigue being the predominant symptom (p = 0.02). Pulmonary function and CPET parameters were comparable between groups, with no evidence of clinically significant ventilatory limitation or impaired aerobic capacity. VO₂peak did not differ between groups. Multivariable regression identified the breathing reserve index and OUES normalized to body weight as strong positive predictors of aerobic capacity in both groups. Despite differences in follow-up duration, stratified analyses using a 24-month cut-off showed comparable physiological findings. Conclusions: Children demonstrated preserved pulmonary function and exercise capacity nearly two years after hospitalization for severe SARS-CoV-2-related RD or MIS-C. Despite these favorable objective findings, subjective symptoms persisted in a substantial subset of patients, particularly those recovering from RD, suggesting that symptom resolution may lag behind objective physiological recovery. OUES normalized to body weight and the breathing reserve index may serve as complementary markers of aerobic capacity. Full article

Background: Pediatric neurologic and neuromuscular illnesses, often progressive and debilitating, require comprehensive medical management focused on enhancing quality of life. Despite the benefits of palliative care in managing symptoms and providing psychological support, there is limited knowledge on its associated factors and utilization for pediatric neurologic and neuromuscular illnesses in hospital settings. Methods: This study analyzed the National Inpatient Sample (NIS) database, covering hospitalizations of children under 18 years with neurologic and neuromuscular diagnoses from 2016 to 2020, to examine associations of palliative care with sociodemographic, clinical, and hospital factors. Results: Out of 139,598 pediatric patients, 4273 (3.1%) received palliative care. Palliative care recipients were younger (mean age 5.3 vs. 6.4 years), had more diagnoses (17.8 vs. 10.9) and procedures (4.0 vs. 2.4), higher illness severity scores (3.4 vs. 2.6), longer LOS (18.7 vs. 9.9 days), and higher hospital charges ($332,559 vs. $150,727). In-hospital mortality was significantly higher among palliative care recipients (32.9% vs. 2.4%). The utilization of palliative care increased annually (OR = 1.08, 95% CI [1.05, 1.11]). Black patients had lower odds (OR = 0.90, 95% CI [0.81, 1.00]). Higher severity scores (OR = 2.09, 95% CI [1.99, 2.20]) were positively associated with palliative care. Smaller hospitals and urban nonteaching hospitals were inversely associated with palliative care utilization. Conclusions: Palliative care utilization for pediatric neurologic and neuromuscular illnesses remains low, with significant disparities based on sociodemographic and hospital-related factors. Enhanced awareness and integration of palliative care in pediatric practice, especially in underutilized settings, are crucial for improving outcomes and quality of life for these patients. Full article

The COVID-19 pandemic shifted pediatric infection epidemiology from bacterial toward viral predominance as public health measures relaxed. To determine how hospital antibiotic prescribing adapted, antimicrobial consumption was characterized and linked to underlying pathogen type. Antibiotic use was retrospectively analyzed among 567 children admitted with a positive microbiological finding to the pediatric ward of a tertiary hospital in Split, Croatia, during the first quarters of 2021–2024. Consumption was quantified using Days of Therapy (DOT), Length of Therapy (LOT), and Days of Antibiotic Spectrum Coverage (DASC) per 1000 patient-days (PD). Antibiotics were grouped by the WHO Access/Watch/Reserve (AWaRe) classification and linked to discharge diagnosis and pathogen type. The proportion of children receiving antibiotics rose from 60.5% (26/43) in 2021 to 71.4% (130/182) in 2024, with the cohort shifting toward younger infants and virally driven diagnoses. DOT, DASC, and DOT/LOT peaked in 2022 (DOT 2164/1000 PD, DOT/LOT 2.2) before settling near 1400/1000 PD, with mean per-day spectrum (DASC/DOT) declining modestly (7.7 to 6.8). Watch-group antibiotics dominated throughout (~80%), with Access contribution of ~20% and Reserve antibiotic use negligible. Ceftriaxone usage rose fivefold (150 to 755 DOT/1000 PD) to become the leading agent. Ceftriaxone and azithromycin were administered more often to children with viral than bacterial infections (respiratory syncytial virus being most common), whereas vancomycin and meropenem were tied to bacterial isolates. These findings identify a high-yield stewardship target and underscore the value of multi-metric, pathogen-aware surveillance. Full article

Background and Clinical Significance: Intranasal foreign bodies are common pediatric otolaryngologic emergencies and are usually diagnosed and removed without difficulty. However, delayed or occult retention may mimic chronic unilateral sinonasal disease and occasionally result in severe inflammatory or infectious complications. This study presents three illustrative pediatric cases of delayed intranasal foreign bodies supported by a seven-year institutional experience. Case Presentation: A retrospective review was conducted of all pediatric patients (≤16 years) presenting with intranasal foreign bodies at a secondary referral hospital between January 2019 and May 2026. Demographic characteristics, clinical presentation, management, and outcomes were reviewed to provide institutional context. Among 82 identified patients, three children with delayed diagnosis and severe complications were selected for detailed presentation because they represented distinct clinical manifestations of prolonged foreign body retention. These included chronic unilateral rhinosinusitis caused by a retained peanut fragment, a medial orbital subperiosteal abscess secondary to a retained plastic nasal piercing component, and a foreign-body granuloma associated with retained nasal packing material. The remaining patients underwent uncomplicated removal, predominantly in the emergency department. Conclusions: The presented cases illustrate the diverse spectrum of complications that may occur following delayed intranasal foreign body retention in children. Persistent unilateral foul-smelling rhinorrhea, nasal obstruction, recurrent unilateral epistaxis, or refractory unilateral sinonasal symptoms should prompt careful evaluation for a retained foreign body. By combining detailed case descriptions with institutional experience, this report highlights the importance of maintaining a high index of suspicion and timely endoscopic management in children with persistent unilateral sinonasal symptoms. Full article

Background: Achilles tendon contracture is a prevalent issue in pediatric populations, often leading to complications such as toe walking and limited ankle dorsiflexion. This study aims to compare the clinical outcomes of two surgical techniques for Achilles tendon lengthening—conventional percutaneous lengthening and Z-plasty—in children with idiopathic Achilles tendon contracture, while assessing the adequacy of a six-week postoperative immobilization period. Methods: A retrospective analysis was conducted on 60 pediatric patients (ages 5–17) who underwent Achilles tendon lengthening at our institution between 2021 and 2025. Patients were divided into two groups: 25 receiving percutaneous lengthening and 35 undergoing Z-plasty. Inclusion criteria encompassed idiopathic contracture with a follow-up of over 12 months. Outcomes measured included ankle dorsiflexion, time to resume normal activities, length of hospital stay, duration of cast immobilization, complications, the likelihood of choosing the same treatment method again, taking analgesics, AOFAS score, and patient/guardian satisfaction. Results: Both surgical methods resulted in significant improvements in ankle dorsiflexion and functional outcomes. The percutaneous group demonstrated a mean increase of 30° in dorsiflexion, while the Z-plasty group showed a mean increase of 32.5°. The time from surgery to resuming normal activities in the Z-plasty group ranged from 6 to 11 weeks, which was significantly higher than the range of 6 to 7 weeks in the percutaneous lengthening group, p = 0.024. Guardian and patient satisfaction was high in both groups, with 94.3% of patients from the Z-plasty group and 100% of patients from the percutaneous group expressing willingness to choose the same treatment again. Four patients (11.4%) from the Z-plasty group and one patient (4%) from the percutaneous lengthening group developed complications. Conclusions: The period of cast immobilization of six weeks helped achieve good outcomes and caused few complications in children from both study groups. The conventional percutaneous approach to Achilles tendon lengthening in children helps achieve substantial correction of ankle dorsiflexion with a low risk of complications. Due to the risk of selection bias, the results should be interpreted with caution. Full article

Automatic sleep stage classification has been extensively studied in adults but remains less explored in children because clinical pediatric polysomnography (PSG) datasets are limited and sleep physiology changes throughout development. In this work, we present a clinical pediatric PSG dataset collected from the archives of Victor Gomoiu Children’s Hospital (VGCH), consisting of 20 overnight recordings from children aged 9–17 years. Using AttnSleep, we assess EEG channel relevance, the contribution of EOG and EMG signals, and adult-to-pediatric transfer learning from SHHS and Sleep-EDFx datasets. Among the individual EEG derivations, P4 achieves the highest cross-validation (CV) means, with 79.5% accuracy and 70.8% balanced accuracy, while several temporal and posterior derivations perform similarly. Adding both EOG channels increases mean accuracy to 82.9%, macro-$F1$ to 74.9%, and balanced accuracy to 75.0%, whereas EMG produces smaller changes. The highest performance is obtained after Sleep-EDFx EEG+EOG pretraining and full fine-tuning on VGCH, reaching 84.0% accuracy, 76.4% macro-$F1$, and 76.4% balanced accuracy. Within this cohort of 20 recordings, the observed patterns highlight the potential value of combining EEG and EOG and support further evaluation of adult-to-pediatric transfer learning for pediatric sleep-stage classification. Full article

Background/Objectives: Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem autoimmune disease that is associated with more severe organ involvement, more intensive drug therapy, and increased long-term organ damage compared with adult-onset disease. The objectives of this study were to evaluate the performance of widely used small area-level multidimensional indicators of neighborhood disadvantage in a mixed urban–rural cSLE cohort against disease outcomes. Methods: This retrospective cohort study utilized electronic health records to identify and evaluate pediatric patients with cSLE across a single center in South Carolina between 1 January 2020 and 31 December 2024. Primary outcomes included disease activity at diagnosis, measured by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K); the achievement of a low lupus disease activity state (LLDAS) by the last visit; the development of major organ involvement; and the rates of unplanned hospitalizations and emergency department visits. The associations of the census tract-level Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Childhood Opportunity Index (COI) with clinical presentation and outcomes were estimated using generalized linear models and logistic regression. Results: A total of 85 patients with cSLE were included, of which 76% reported being of Black race, and 28% lived in rural areas. Lupus disease severity was inconsistent across the metrics of area-level social vulnerability, neighborhood deprivation, child opportunity, and rurality. Patients who lived in more socially vulnerable communities were more likely to attain LLDAS during follow-up, while those who lived in lower-opportunity areas were more likely to develop CNS lupus. Baseline disease activity, renal involvement, and healthcare use were not significantly associated with area-level social disadvantages or rurality. Conclusions: In this single-center, mixed urban–rural cohort of children with cSLE, indicators of neighborhood-level disadvantage and rurality alone explained little variation in disease severity and disease control overall. The utility of available small area-level metrics is likely context-dependent and influenced by regional features, population characteristics, and the outcomes being studied. Future work should integrate individual- and area-level factors across diverse settings to better understand the drivers of health disparities. Full article

Objective: Our objective was to compare clinical safety and postoperative efficacy between transvesicoscopic Politano–Leadbetter (TPL) and laparoscopic Lich–Gregoir (LLG) ureteral reimplantation in infants and toddlers under 36 months diagnosed with primary obstructive megaureter (POM). Methods: This was a single-center retrospective cohort study of pediatric patients with POM who underwent ureteral reimplantation between January 2018 and April 2025. Patients were stratified into TPL and LLG groups by surgical approach. Baseline characteristics, perioperative outcomes, perioperative complications, imaging findings, renal functional outcomes, and long-term complications were collected and analyzed. Primary group comparisons were unadjusted, with additional multivariable linear regression performed for operative duration. Results: We enrolled 65 children: 30 in the TPL group and 35 in the LLG group. Baseline characteristics showed no statistically significant differences across the two study cohorts. There were no open conversions in either group. Total operative duration did not differ significantly between the TPL and LLG groups (145.8 ± 30.6 min vs. 136.9 ± 25.2 min; mean difference, 8.9 min; 95% CI, −4.9 to 22.7; p = 0.210). In multivariable linear regression, TPL showed a non-significant trend toward longer operative time after adjustment for age, preoperative ureteral diameter, and surgery year (B = 10.4 min; 95% CI, −3.7 to 24.4; p = 0.141). Time to postoperative oral intake was slightly shorter in the TPL group (6.1 ± 2.3 h vs. 8.2 ± 2.9 h; mean difference, −2.1 h; 95% CI, −3.4 to −0.8; p = 0.002). No statistically significant differences were detected in estimated blood loss, ureteral tapering rate, double-J stent placement rate, postoperative pain score, acetaminophen use, urinary catheterization duration, or length of hospital stay. Perioperative complications occurred in 3 patients in the TPL group and 5 patients in the LLG group (10.0% vs. 14.3%; risk difference, −4.3%; 95% CI, −20.1% to 11.5%; p = 0.716). No Clavien–Dindo grade III or higher complications occurred in either group. During follow-up, both groups showed reductions in anteroposterior pelvic diameter (APD) and ureteral diameter (UD), with preserved differential renal function (DRF). Low-grade postoperative vesicoureteral reflux (VUR) was detected in two LLG patients, including one grade I case at 4 months and one grade II case at 6 months after surgery; both were managed conservatively. Neither group experienced recurrent ureterovesical junction obstruction (UVJO) nor required reoperation during follow-up. Conclusions: In this single-center retrospective cohort of infants and toddlers with POM, no statistically significant differences were detected in the main perioperative and follow-up outcomes between TPL and LLG. TPL enables intravesical reconstruction and better preserves the natural anatomical course of the ureter and may serve as an alternative minimally invasive option for this patient population. Full article