Thrombotic microangiopathy (TMA) is a clinical-pathological syndrome defined by microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction, commonly affecting the kidneys. The etiologies are diverse and include genetic disorders (affecting complement proteins or other pathways, such as cobalamin metabolism), infections, autoimmune diseases, malignancies, transplantation, pregnancy, and drugs. Differentiating these causes is essential, as treatment strategies and prognoses vary widely. This consensus document, developed by a multidisciplinary group of clinicians and geneticists, provides a structured approach for evaluating TMA, with particular focus on complement-mediated TMA (C-TMA). C-TMA should be considered when TMA features persist after resolution or exclusion of secondary causes. Diagnostic confirmation relies on clinical judgment, histopathology, and a favorable response to C5 complement inhibitors, such as eculizumab or ravulizumab. This therapeutic response is considered both diagnostic and prognostic. Complement gene variants (e.g., CFH, CFI, MCP/CD46, and others) and copy number variations (e.g., CFHR1-5 deletions) are found in up to 50–60
PURPOSE:To evaluate the effectiveness and safety of computed tomography (CT)-guided ethiodized oil marking for thoracoscopic excisional biopsies of pulmonary nodules in children with cancer. MATERIALS AND METHODS:This was a retrospective, single-center study conducted between January 2014 and June 2024 of pediatric patients with cancer who underwent thoracoscopic resection of pulmonary nodules localized using a preoperative ethiodized oil marking technique. A total of 30 patients underwent 36 thoracoscopic procedures using ethiodized oil-guided localization. The mean age was 11.5 years (SD ± 4.2). RESULTS:There were a total of 52 pulmonary nodules localized and resected, with a mean size of 3.7 mm (SD ± 1.9) and a mean distance from the pleural surface of 5.6 mm (SD ± 4.1). The mean time between marking and surgery was 23.3 hours (SD ± 12.3). At the surgical resection, 53 (98.1%) of 54 nodules were successfully localized using ethiodized oil and removed. The remaining, unlocalized nodule was resected using anatomical landmarks. One patient experienced localized vascular ethiodized oil infiltration without further extension or clinical consequences. Small rim pneumothorax developed in 9 patients (mild adverse event [AE]), with only 1 requiring chest tube placement (moderate AE). No hemothorax or postprocedural hematoma occurred. CONCLUSIONS:CT-guided ethiodized oil marking proved to be a safe and effective method for localizing small pulmonary nodules before thoracoscopic resection in pediatric patients, achieving high success rates with minimal complications.
Stiff skin syndrome (SSS) is a rare pediatric sclerosing disorder characterized by progressive fibrosis and mobility restriction. We report a 10-year-old girl with progressive skin induration whose diagnosis was supported by histopathology and high-resolution skin ultrasound. Ultrasound demonstrated dermal thickening and prominent hypodermal fibrous septa, findings that correlated with the characteristic hypoinflammatory lattice arrangement seen on histology. This case highlights the diagnostic value of integrating advanced imaging and pathology to ensure accuracy and avoid treatment delays, particularly in resource-limited settings where genetic testing is unavailable.
Operating-room allocation is a major challenge for public hospitals with limited surgical capacity and large elective waiting lists. This work proposes a two-stage operating-room allocation framework for specialty-block scheduling environments. The methodology combines a mixed-integer linear programming model for medical specialty block allocation with a priority-based patient allocation procedure. The framework was evaluated through one-week and multi-week simulation scenarios using parameters estimated from historical surgical and waiting-list data. The proposed methodology was compared against an integrated mixed-integer linear programming baseline adapted from the literature under realistic operational disruptions, including failed patient confirmations and surgery suspensions. Results show that the proposed framework achieves a more balanced distribution between offered and demanded surgical time across specialties while maintaining high operating-room utilization and substantially lower computational times than the integrated baseline. In the 20-week scenario, the proposed methodology achieved lower waiting times and operated a larger number of patients while preserving operational flexibility. These results suggest that decomposition-based operating-room allocation strategies provide a practical and computationally efficient alternative for reducing surgical waiting lists in public hospitals.
Background:Pediatric hospice and palliative medicine (PHPM) is a growing subspecialty worldwide; however, formal graduate medical education pathways remain limited in low- and middle-income countries, including most of Latin America, constraining workforce development and access to specialized care. Objective:To describe an educational innovation that provides formal fellowship training in PHPM to physicians in Latin America. Methods:From 2023 to 2026, Unidad Nacional de Oncología Pediátrica (Guatemala), St Jude Children's Research Hospital, and the University of Utah developed and implemented a PHPM fellowship program in Latin America. The curriculum emphasizes culturally responsive training and ACGME International (ACGME-I) core competencies. Program outcomes, feasibility, and acceptability were assessed using mixed methods. Quantitative data were collected via anonymous ACGME-I program evaluation surveys completed by 10 participants over 2 years, representing a 100% response rate from fellows (n=2) and a 57% response rate from core faculty mentors (n=8 of 14 eligible). Qualitative data were obtained from written reflections and monthly structured debriefings with faculty (n=14) and fellows (n=2) from March to August 2025. Results:Three fellows completed or are completing training, and the program received ACGME-I initial accreditation in February 2026. Graduates demonstrated early workforce impact, including expansion of PHPM services in Chile and planned implementation of the Dominican Republic's first non-oncologic public PHPM program. All survey respondents agreed that the program provided a high-quality curriculum and effective career preparation. Qualitative analysis identified themes of strong mentorship, clinical relevance, and feasibility. Conclusions:This trilateral PHPM fellowship is an internationally partnered, regionally grounded training that demonstrates early feasibility, acceptability, and educational value.
