Sepsis is defined as a dysregulated host response to infection that leads to life-threatening organ dysfunction. The infectious insult triggers a dysregulated immune response that variably activates and suppresses multiple body system functions. Susceptibility to either developing or succumbing to sepsis is influenced by pathogen load and virulence; site of infection; host factors, including genetics, biological variability, comorbidities, immunosuppression, and extremes of age; and a wide range of external influences, such as social deprivation and local environment. Increasing appreciation of the underlying pathobiology has identified differing biological signatures with variable temporal evolution. This variability highlights the requirement to individualise treatment with targeted interventions guided by rapidly accessible biomarkers. Although improved outcomes have been obtained with better prevention, early recognition, and treatment, sepsis is a major cause of global mortality and morbidity. All populations having the benefits currently enjoyed by a privileged few is imperative. This Seminar aims to unravel the complexity of the condition, describing epidemiology and pathophysiology, evolving fundamental shifts, patient management, current challenges, and future developments.
The evaluation of injured children often involves imaging to assist in diagnosis and management. Many of these imaging tests involve exposure to ionizing radiation, which has been linked to future malignancies. Judicious use of diagnostic tests that expose a child to radiation is an important consideration when identifying children at risk for serious injury. Recognition of children who require a higher level of care and coordination with the receiving center should be a priority prior to obtaining advanced imaging. Detection of injury must be balanced with the risk of ionizing radiation in the pediatric trauma population. This principle has guided a field of pediatric trauma research and resulted in multiple guidelines and algorithms to assist in the diagnosis and management of traumatic injuries. Our review of recent literature shows reference to the Pediatric Emergency Care Applied Research Network (PECARN), Choosing Wisely recommendations, Pediatric Cervical Spine Clearance Working Group guidelines, as well as several recent studies guiding pediatric trauma. There is an emphasis on limiting the use of ionizing radiation imaging, the importance of clinical presentation guiding management, as well as understanding a center’s capabilities and ensuring expedited transfer to referral pediatric trauma centers. The “screen before you scan” approach using evidence-based clinical decision tools can assist in identifying pediatric patients who would benefit most from imaging. With the known risks of radiation in trauma patients, especially in children, more and more evidence-based clinical guidelines to “screen before you scan” are now being utilized to assist in identifying pediatric patients that can be managed with minimal use of ionizing radiation while maintaining safe clinically important injury detection rates while minimizing missed injuries.
Background:Pediatric low-grade gliomas (pLGGs) are the most common childhood central nervous system (CNS) tumors. Targeted therapies are effective treatments in patients with pLGGs harboring mutations in the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase 1/2 (ERK) signaling pathway. Understanding the toxicity profile and tolerability of emerging MAPK inhibitors (MAPKi) and how adverse events (AEs) can be managed to avoid treatment discontinuation, interruption, or dose reduction is important for optimizing clinical benefit. Methods:A modified Delphi consensus initiative was conducted to provide recommendations on the monitoring and management of AEs that occur with MAPKi in patients with pLGG. A 9-member steering committee was convened to develop statements based on the findings of a comprehensive literature review of AEs reported with the use of MAPKi in pediatric cancers. Consensus on statements was determined via online surveys completed by a large, global panel of experts in pLGG. Results:Of the 129 statements drafted, consensus (≥75% agreement) among 82 global experts in pLGG was reached for 50 statements, mostly pertaining to the general management of AEs occurring with MAPKi and the management of cutaneous AEs. Consensus statements include guidance on skin care and specific cutaneous conditions. Many AEs were rare with limited evidence or experience to achieve consensus recommendations. Conclusions:The consensus statements developed provide guidance and recommendations for the management of common AEs in patients with pLGG treated with MAPKi. Sharing this knowledge may lead to patients with pLGG achieving optimal benefit from MAPKi while minimizing and effectively managing AEs.
The purpose of this systematic review was to survey the content and structure of sexuality interventions for autistic people across the lifespan. Recent research has identified a lack of attention to autistic people’s needs when designing sexual ed interventions. Due to an increased acknowledgment of the substantial barriers to comprehensive sex education for autistic people, interventions have been implemented across settings, age groups, and methods, but there is little consistency surrounding what content should be included in these interventions. Through our systematic review, we identified 23 articles focused on sexuality and relationship interventions for autistic people. Analysis revealed coverage of a wide variety of topics in curricula, with education around consent and boundary setting or levels of intimacy/dating being the most frequently taught topics. Most interventions were implemented with autistic people, although some did focus on teaching skills to parents or caregivers, who can play an important role in education and skill development. Results provide an important foundation to understand content areas currently included in sex education interventions and identify areas that should receive more attention in future interventions developed for autistic people of all ages.
Measuring differential renal function (DRF) is critical for managing children with congenital and acquired urological diseases. MAG-3 renal scintigraphy is the most widely used clinical technique; dynamic contrast-enhanced MRI (DCE-MRI) provides a radiation-free and high-resolution alternative method for assessing DRF. To evaluate the agreement between DRF values derived from DCE-MRI and MAG-3 scintigraphy-derived DRF in pediatric patients. This retrospective study included 23 pediatric patients (age range, 3 months-20 years; mean±SD, 8.3±7.4 years) who underwent DCE-MRI embedded in MR urography (MRU) protocol and MAG-3 studies within 6 months. DCE-MRI was performed using a golden-angle radial dynamic stack-of-stars acquisition with golden-angle sparse parallel (GRASP) reconstruction, and analyzed the renal filtration rate with a two-compartment tracer kinetic model. DRF values from DCE-MRI were compared with those from MAG-3, using both default (n=23) and C-shaped background regions for MAG-3 analysis, where raw data were available (n=16). Agreement was evaluated using Bland–Altman analysis, Pearson and concordance correlations, and paired statistical tests. With default MAG-3 background analysis (n=23), mean DRF difference (MAG-3 minus DCE-MRI) was 0.4
