Acute intestinal infections remain one of the leading causes of morbidity among children under five years of age and represent an important public health challenge in both developed and developing countries. Although these infections often share similar clinical manifestations, their etiological structure, severity, diagnostic accessibility, treatment approaches, and prevention strategies differ considerably depending on socioeconomic conditions, sanitation, healthcare infrastructure, and vaccination coverage. Aim: This review aims to summarize current data on the epidemiology, etiology, clinical presentation, diagnosis, treatment, and prevention of acute intestinal infections in children aged 1–5 years, as well as to provide a comparative analysis of approaches in countries with different income levels. Methods: A review of scientific literature focused on acute intestinal infections in young children was conducted. Source selection included full-text assessment. The extracted data were summarized descriptively according to pathogen groups: viral, bacterial, and protozoal infections. A PRISMA flow diagram was used to present the source selection process. Results: The reviewed literature indicates that viral pathogens, particularly rotavirus and norovirus, are among the leading causes of acute gastroenteritis in children under five years of age. According to Global Burden of Disease 2021 estimates, approximately 392.8 million diarrhoeal episodes and 0.34 million deaths occurred among children under five years of age globally in 2021, with mortality disproportionately concentrated in sub-Saharan Africa and South Asia. Bacterial infections, including Shigella and diarrheagenic Escherichia coli, are less frequent but are more often associated with invasive disease, severe diarrhea, and systemic complications. Protozoal infections, including Giardia lamblia, may contribute to prolonged diarrhea, especially in children with malnutrition or weakened immune status. Substantial regional differences were identified in pathogen distribution, antimicrobial resistance, diagnostic capacity, access to healthcare, and vaccination coverage. In developing countries, the disease burden remains strongly associated with limited access to safe water, sanitation, timely diagnosis, and appropriate medical care, whereas in developed countries acute intestinal infections more commonly contribute to outbreaks, emergency department visits, and hospitalizations. Conclusions: Acute intestinal infections in children aged 1–5 years remain an important global health burden with substantial regional disparities. Effective prevention and control require context-specific strategies combining high vaccination coverage, improved water, sanitation and hygiene, timely pathogen-specific diagnosis, rational antimicrobial use, and strengthened surveillance, with particular priority given to high-burden and resource-limited settings.
Background/Objectives: Unfavorable outcomes after locking plate fixation of geriatric proximal humerus fractures impair arm function and put social independence at risk. At short-/medium-term follow-up, comparable results have been demonstrated between deltoid-split (DS) and deltopectoral (DP) approaches, while few studies reported superior function in favor of either DP or DS. However, long-term results in comparison are lacking. The aim of this study is to evaluate the long-term influence of surgical approaches in locking plate fixation of geriatric proximal humerus fractures. Methods: N = 39 patients (age 69.00 y (IQR 21); 25 females, 14 males) were finally included in this monocentric retrospective investigation and divided into DS and DP subgroups (baseline population n = 88, n = 49 lost to follow-up). Demographics and injury-/surgery-related data were retrieved. Constant–Murley Score (CS), DASH and Subjective Shoulder Value (SSV) were recorded. Descriptive/explorative statistical analysis was performed, and group differences were evaluated (significance level p < 0.05). Results: The distribution of demographics and injury-/surgery-related data was comparable between DS and DP. The length of stay and duration of surgery did not differ (p > 0.05). Follow-up was assessed at 80.18 ± 7.77 mo (min 60.00 mo). The complication/revision rate was 12.8%. Neither CS nor DASH differed between DS (CS: 73.50 (IQR 42.00; 95% CI: 51.00–87.00); DASH: 15.65 (IQR 28.60; 95% CI: 9.40–18.50)) and DP (CS: 69.00 (IQR 20.00; 95% CI: 63.00–83.00); DASH: 17.10 (IQR 14.50; 95% CI: 8.40–22.90); CS: p = 0.950; DASH: p = 0.786), and SSV was measured equally (p = 0.344). Conclusions: The choice of surgical approach (DS versus DP) did not show a significant influence on long-term outcome after locking plate fixation of geriatric proximal humerus fractures in this study. The results regarding short-/medium-term follow-up are confirmed. Depending on the surgeon’s preference and experience, both approaches seem to represent viable alternatives for humeral head-preserving surgical management. Future studies utilizing larger, adequately powered cohorts are required.
Gastric neuroendocrine tumors (G-NETs) represent a heterogeneous group of neoplasms, traditionally classified into three types with distinct pathophysiological backgrounds, biological behavior, and prognosis. Endoscopic treatment plays a central role in the management of type I G-NETs, ranging from endoscopic surveillance to resection with conventional or more advanced techniques. These include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and, more recently, modified EMR techniques and endoscopic full-thickness resection (EFTR). However, in the absence of high-quality comparative data, the optimal selection among these approaches remains uncertain. Furthermore, incomplete (R1) resection and tumor recurrence represent clinically relevant scenarios frequently encountered in the management of type I G-NETs. However, the clinical significance of R1 resection and the factors associated with recurrence remain incompletely understood, making their subsequent management and surveillance challenging. In type III G-NETs, surgical treatment has traditionally represented the standard approach due to their more aggressive behavior; however, increasing evidence supports the role of endoscopic treatment in carefully selected patients. This review discusses clinically relevant aspects of the endoscopic management of G-NETs, while also highlighting the limitations and gaps in the available evidence and identifying areas for future research. Ultimately, through a critical interpretation of current evidence, this review aims to provide practical guidance for clinical decision-making and contribute to a more evidence-based approach to the management of G-NETs.
Background: Griscelli syndrome type 2 is a rare autosomal recessive disorder caused by pathogenic variants in the RAB27A gene, characterized by partial albinism, immunodeficiency, and a high risk of hemophagocytic lymphohistiocytosis (HLH). Case descriptions: We report two unrelated Mexican patients with GS2 harboring the same homozygous RAB27A frameshift variant (c.335del; p.Asn112Thrfs*3) and describe their clinical and immunological features. Both patients presented with silvery-gray hair and subsequently developed HLH, although with variable onset and clinical course. One patient initially manifested with isolated central nervous system involvement, lacking systemic or laboratory abnormalities, which led to diagnostic uncertainty and delayed treatment. The second patient presented early in life with classical systemic features of HLH. Despite treatment with standard HLH-directed therapy, both patients experienced disease reactivation and ultimately died before undergoing hematopoietic stem cell transplantation. The homozygous pathogenic RAB27A variant (c.335del; p.Asn112Thrfs*3) was identified by polymerase chain reaction followed by Sanger sequencing in the two index cases; both sets of parents were heterozygous carriers. Comparison with previously reported cases carrying the same variant highlights notable phenotypic variability despite a shared genotype. The recurrence of this variant exclusively in individuals of Hispanic origin raises the possibility of a founder effect. Conclusions: These findings underscore the importance of early recognition of pigmentary abnormalities, the integration of clinical and molecular diagnostics approaches, and the consideration of HLH in patients presenting with atypical neurological manifestations. Early diagnosis is critical to enable prompt therapeutic intervention and improve clinical outcomes.
Background: Early initiation of high-efficacy treatment (HET) in patients with demyelinating central nervous system (CNS) diseases is associated with improved long-term prognosis. Identifying parameters linked to delayed HET initiation could facilitate strategies to optimize timely treatment. Objective: This study aims to identify clinical and sociodemographic parameters that influence the interval between recommendation and initiation of HET in patients with multiple sclerosis (MS) and related disorders. Methods: In this single-center retrospective cohort study, electronic health records of 136 patients who received a recommendation for HET between January 2016 and August 2023 at the Department of Neurology, Goethe University Frankfurt, were reviewed. Clinical and sociodemographic variables were tested for their relationship with time delay using parametric and non-parametric methods; independent predictors were identified by multivariable linear regression, with p-values corrected using the Benjamini–Hochberg false-discovery-rate procedure. Results: Mean time delay between HET recommendation and initiation was 144.3 days (±86.4). After correction for multiple comparisons, four variables remained independent predictors of time delay: a higher expanded disability status scale (EDSS) score at recommendation (q = 0.034) and a greater number of prior disease-modifying treatments (DMTs; q = 0.009) were associated with longer delays, whereas an explicit recommendation for HET initiation prior to completed immunization (q < 0.001) and an active relapse at recommendation predicted shorter delays (q < 0.001). In a model with reduced complexity, the predictors kept their significance with the exception of a number of prior DMTs. Here, the occurrence of temporary illness between HET recommendation and initiation gained significance. Conclusion: Patients with higher baseline disability appear prone to delayed HET initiation and may benefit from closer monitoring during transition to HET, whereas active relapses seem to prompt more timely treatment decisions. The number of prior DMTs and the occurrence of temporal illness between HET recommendation and initiation might be relevant for the time delay, too, although here future, better powered studies should replicate the effects.
