Recommendations For Clinical Practice Research Articles

Is There a Need to Reassess Protein Intake Recommendations Following Metabolic Bariatric Surgery?

Protein intake is recognized as a key nutritional factor crucial for optimizing Metabolic Bariatric Surgery (MBS) outcomes by preventing protein malnutrition, preserving fat-free mass, and inducing satiety. This paper discusses the current evidence regarding protein intake and its impact on clinical outcomes following MBS. There are considerable gaps in the understanding of protein requirements following MBS, as existing guidelines are based on limited and inconsistent reports. This highlights the urgent need for updated clinical practice recommendations grounded in high-quality evidence. Further investigation using robust methodologies is essential to address existing research gaps related to the individualization of protein requirements following MBS. Future research should consider factors such as the time elapsed since surgery, the form and quantity of protein consumed, and necessary adjustments for physical activity. Ultimately, in alignment with recent literature, a more specific and personalized dietary protein approach should be examined.

Exploring the clinical, psychological, and social relevance of menopause for trans and gender diverse people: a qualitative study.

The aim of this study was to explore the meanings and experiences of menopause for trans and gender diverse (TGD) people and how menopause affects clinical practice. For this qualitative study in 2021-2022, a scoping literature review informed interview schedule development. Following email invitations, online semi-structured interviews were conducted in March-April 2021 in Australia with three prominent TGD community leaders (trans male, trans female, nonbinary person) and three experienced medical practitioners (general practitioner, endocrinologist, psychiatrist), which were audio-recorded and transcribed. Inductive, iterative thematic analysis of transcripts was conducted. A further literature search was completed in 2024. Themes identified included the following: (1) no consensus on the definition of menopause for TGD individuals; (2) diverse menopause experiences existing in the TGD community; (3) large variations present regarding perimenopausal hormone therapy for older TGD patients: maintain dose, taper to low dose, or cease hormones; and (4) minimal support for TGD people to discuss menopause and concerns around aging. Saturation was not reached with the sample size. There is a paucity of relevant research and no consensus on definitions, management, or impacts of menopause for TGD people. Therefore, current management approaches should be individually tailored and guided by clinical expertise. To formulate practical and realistic recommendations for clinical practice, future research could include the following: (1) a broader literature review into varied gender-affirming hormone treatment (GAHT) regimens among aging TGD people; (2) utilizing the Delphi technique to achieve expert consensus regarding GAHT in older TGD individuals; and (3) a prospective study design of TGD participants on different GAHT regimens over time.

Guideline on managing thumb base osteoarthritis: The British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) findings and recommendations.

This review paper provides a summary of the evidence for non-surgical and surgical management of thumb base osteoarthritis and suggests guidelines through Clinical Practice Recommendations including Good Practice Points and a Patient Flow Algorithm. The guidelines were developed through systematic reviews in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence. A stepwise approach is recommended with initial non-invasive treatment consisting of a comprehensive and multimodal package of supported self-management. Splints should be additionally considered for those who have not responded to a self-management package alone. Intra-articular corticosteroid injections should be considered in those who have not responded to non-invasive treatment. If symptoms fail to resolve, surgery should be considered. Additional procedures such as interposition or ligament reconstruction do not appear to confer any benefit over excision of the trapezium alone.

Prenatal diagnosis following preimplantation genetic testing for monogenic conditions: a single centre record linkage study.

Professional bodies currently advise all pregnant individuals undertake confirmatory prenatal diagnostic testing following preimplantation genetic testing for monogenic conditions (PGT-M). We aimed to ascertain the uptake of prenatal diagnostic testing following PGT-M in a large single-centre population. This observational linkage study was undertaken using routinely collected outcome data from PGT-M cycles performed at one of Australia's largest PGT-M providers and a statewide dataset of all prenatal samples undergoing cytogenetic analysis in Victoria, Australia, between 2015 and 2022. During the study period, there were 176 clinical pregnancies following the transfer of a PGT-M-tested embryo in 132 patients. Eleven patients undertook confirmatory prenatal diagnostic testing in 12 pregnancies, representing a confirmatory testing rate of 8.3% [95% CI: 4.7-14.3%] per patient and 6.8% [95% CI: 3.9-11.5%] per pregnancy. The 176 clinical pregnancies resulted in 154 (87.5%) live births and pregnancies ongoing at the time of reporting, 21 (11.9%) pregnancy losses ≤ 20weeks gestation, and 1 (0.6%) stillbirth. Most patients who conceive following the transfer of a PGT-M-tested embryo do not undertake confirmatory prenatal diagnostic testing. The low uptake of confirmatory testing raises important considerations for genetic counselling for PGT-M and the acceptability of current clinical practice recommendations.

The Brussels consensus for non-invasive ICP monitoring when invasive systems are not available in the care of TBI patients (the B-ICONIC consensus, recommendations, and management algorithm).

Invasive systems are commonly used for monitoring intracranial pressure (ICP) in traumatic brain injury (TBI) and are considered the gold standard. The availability of invasive ICP monitoring is heterogeneous, and in low- and middle-income settings, these systems are not routinely employed due to high cost or limited accessibility. The aim of this consensus was to develop recommendations to guide monitoring and ICP-driven therapies in TBI using non-invasive ICP (nICP) systems. A panel of 41 experts, that regularly use nICP systems for guiding TBI care, was established. Three scoping and four systematic reviews with meta-analysis were performed summarizing the current global-literature evidence. A modified Delphi method was applied for the development of recommendations. An in-person meeting with group discussions and voting was conducted. Strong recommendations were defined for an agreement of at least 85%. Weak recommendations were defined for an agreement of 75-85%. A total of 34 recommendations were provided (32 Strong, 2 Weak) divided into three domains: general consideration for nICP use, management of ICP using nICP methods and thresholds of nICP tools for escalating/de-escalating treatment. We developed four clinical algorithms for escalating treatment and heatmaps for de-escalating treatment. Using a mixed-method approach involving literature review and an in-person consensus by experts, a set of recommendations designed to assist clinicians managing TBI patients using nICP systems plus clinical assessment, in the presence or absence of brain imaging, were built. Further clinical studies are required to validate the potential use of these recommendations in the daily clinical practice.

N25 A qualitative study exploring health professionals’ experiences and understanding of the sexual health and associated care needs in men with Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD) can negatively affect men’s sexual well-being and alter the way in which they engage in sexual activities (1). People with IBD in the UK have reported that health professionals are reticent to initiate discussions about their sexual health (1, 2). There is a paucity of research exploring men’s sexual health in IBD (3). This study aimed to describe and interpret the experiences of healthcare practitioners (HCPs) working in IBD within the UK to explore current practice in relation to the assessment of sexual health of men with IBD, understand the perceived barriers and facilitators to engaging with men about their sexual health and inform recommendations for clinical practice, education, and research. Methods A qualitative interpretive description design (4) using individual, online semi-structured interviews. Participants were UK health professionals purposively sampled and recruited through advertising the study through professional IBD organisations, conferences and online networks. Interviews were transcribed verbatim and analysed using thematic analysis. Results 19 HCPs participated in the study: 10 nurses, 6 medical doctors, 2 clinical psychologists and 1 dietitian. Participants had worked with IBD patients for between 6 months and 22 years (mean 13 years, SD 9.66),14 were female, 5 were male. Participants’ experiences of sexual health discussions, assessment, and provision of care were apparent through two emergent themes. The first theme, ‘it’s difficult to discuss sex’ represented personal, professional, and societal barriers to discussing sexual health with male IBD patients. The second theme, ‘service transformation is needed’, encapsulated the service-related barriers faced by both patients and HCPs and the possible adjustments required to facilitate the identification and support of men’s sexual health and well-being needs within clinical practice. Several sub-themes reflected the perceived barriers faced by HCPs including: 'feeling ill-equipped', 'ask the IBD nurses, they’ll know', 'men tend to bravado', 'a fire-fighting service', and 'creating a safe environment'. Conclusion IBD healthcare practitioners working in the UK may face personal, professional, organisation, and societal barriers to providing assessment and support for the sexual health and care needs of men with IBD. It is likely that these barriers may be moderated by improving the availability of sexual healthcare resources and developing treatment pathways that promote cohesive multi-disciplinary working. Future research should focus on how HCPs can be supported to become comfortable and proficient at initiating sexual health conversations that are inclusive of psychosocial-sexual needs. References (1)Ma S, Knapp P, Galdas P. "My sexual desires, everything, my normal life just stops"; a qualitative study of male sexual health in inflammatory bowel disease. Journal of Clinical Nursing. 2024. doi:10.1111/jocn.17292 (2)Fourie S, Norton C, Jackson D, Czuber-Dochan W. "These discussions aren’t happening". Experiences of people living with inflammatory bowel disease talking about sexual well-being with healthcare professionals. Journal of Crohn’s and Colitis. 2021;15(10):1641-1648. doi:10.1093/ecco-jcc/jjab043 (3)Ma S, Veysey M, Ersser S, Mason-Jones A, Galdas P. The impact of inflammatory bowel disease on sexual health in men: A scoping review. Journal of Clinical Nursing. 2020:(19-20):3638-3652. doi:10.1111/jocn.15418 (4)Thorne S. Interpretive Description: Qualitative Research for Applied Practice. Routledge; 2016.

Guideline-directed medical therapy for heart failure: Real-world evidence in one Latin-American center.

Despite recommendations from clinical practice guidelines to initiate four drug classes in patients with heart failure (HF) with reduced ejection fraction, information on real-world implementation remains limited. This study evaluated the medications initiated and titrated, the time until the optimal treatment tolerated, pharmacological profiles, patient's adherence, and causes of non-use of guideline directed-medical therapy (GDMT) in a cohort of patients with HF. A retrospective cohort study was conducted on patients treated in a heart failure program in Colombia. Optimal treatment tolerated was defined as that achieved within 6 months of follow-up. Medication adherence was assessed using the 4-item Morisky-Green scale. A total of 471 patients were included, with a median age of 76 years, 56.9 % male, and a median left ventricular ejection fraction of 35 %. Overall, 43.9 % of patients were on GDMT quadruple therapy, with a median time to optimal tolerated treatment of 57 days (IQR: 1-133). More than 90 % reached target doses with mineralocorticoid receptor antagonists and SGLT2 inhibitors, while less than 50 % achieved it with beta-blockers and renin-angiotensin-aldosterone system inhibitors. Adherence, according to the Morisky-Green scale, was 89.9 % and main causes of non-adherence were lack of social-family support (46.8 %) and forgetting to take medication (44.7 %). In this real-world study of patients with HF, GDMT use rates were higher than those previous national registries. However, the medication doses were lower than those recommended by clinical guidelines. Identifying and quantifying adherence barriers in low- or middle-income countries is essential for implementing recommendations in clinical practice.

Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia.

X-linked hypophosphataemia (XLH) is a rare metabolic bone disorder caused by pathogenic variants in the PHEX gene, which is predominantly expressed in osteoblasts, osteocytes and odontoblasts. XLH is characterized by increased synthesis of the bone-derived phosphaturic hormone fibroblast growth factor 23 (FGF23), which results in renal phosphate wasting with consecutive hypophosphataemia, rickets, osteomalacia, disproportionate short stature, oral manifestations, pseudofractures, craniosynostosis, enthesopathies and osteoarthritis. Patients with XLH should be provided with multidisciplinary care organized by a metabolic bone expert. Historically, these patients were treated with frequent doses of oral phosphate supplements and active vitamin D, which was of limited efficiency and associated with adverse effects. However, the management of XLH has evolved in the past few years owing to the availability of burosumab, a fully humanized monoclonal antibody that neutralizes circulating FGF23. Here, we provide updated clinical practice recommendations for the diagnosis and management of XLH to improve outcomes and quality of life in these patients.

Clinical Practice Guideline: The Diagnosis and Treatment of Osteoporosis.

Osteoporosis is a common disease that affects approximately 6 million people in Germany alone. Osteoporotic fractures impair the quality of life and may make independent living impossible. Recommendations on the diagnosis and treatment of osteoporosis are indispensable for the effective care of this large group of patients. For a thorough updating of the German clinical practice guideline (an evidence-based guideline with recommendations for clinical practice) on osteoporosis, a comprehensive, systematic search for relevant publications was carried out, including guidelines from other countries. The retrieved literature was assessed with standardized (Oxford) criteria, and clinically relevant key questions were answered according to the PICO scheme ("population, intervention, comparison, outcomes"). The assessment of clinical risk factors for osteoporosis is the basis of osteoporosis diagnostics, which should be carried out quickly after a fracture. If risk factors are present in a postmenopausal woman or a man aged 50 or above, bone densitometry testing with dual-energy x-ray absorptiometry (DXA) is recommended. The further diagnostic evaluation should proceed in stepwise fashion depending on the clinical symptoms, the fracture status, and the degree of bone density reduction. Pharmacotherapy should be adapted to the fracture risk. Osteoanabolic treatment is recommended with high priority if the patient is judged to have a very high risk of fracture (10% or more in the next three years). The further course and duration of treatment should be determined individually, depending on the evolution of the patient's clinical state. Prerequisites for the optimal treatment of patients with osteoporosis include a correct diagnosis and interdisciplinary and interprofessional collaboration to determine and provide the proper treatment. 71% of persons with osteoporosis in Germany are still untreated, and this gap must be closed.

Dent disease: Clinical Practice Recommendations.

Dent disease is a rare X-linked tubulopathy that is characterized by low-molecular-weight (LMW) proteinuria associated with hypercalciuria, which may lead to nephrolithiasis, nephrocalcinosis, and kidney failure between the 3rd and the 5th decades of life in 30-80% of affected males. The disease is most often associated with various manifestations of proximal tubular dysfunction. Affected individuals may present nephrotic range proteinuria which may be misinterpreted and cause diagnostic delay. Due to its rarity, there is limited evidence to guide diagnosis and management. This clinical practice recommendations summarize the current knowledge on Dent disease and provide guidance for diagnosis and management. The recommendations are based on a systematic search of the literature and were endorsed by a Delphi procedure among stakeholders in the field as well as the respective ERA and ESPN working groups.

Evaluation of the Application of Clinical Practice Guideline Recommendations on the Classification of Patients With Neck Pain.

Background: Clinical practice guidelines (CPGs) are developed to synthesize evidence into recommendations for clinical practice. Minimal evidence exists on the evaluation practice of physical therapists in the treatment of patients with neck pain. Purpose: We sought to describe (1) the extent to which clinicians perform the Neck Pain CPG-recommended examination measures and (2) the percentage of patients properly classified. Methods: We retrospectively analyzed the electronic health records of 397 patients with neck pain at an ambulatory care setting in an academic medical center. The frequency of physical therapists' evaluation measures, subjective findings, positive examination results, and the percentage of patients properly classified into impairment-based categories (IBCs) were recorded. Descriptive statistics and χ2 tests were used to assess patient demographics and compare classification accuracy across IBCs. Results: Of the 397 patients, 56% were classified into an IBC. The most common IBC was neck pain with mobility deficits (24%), followed by neck pain with radiating pain (17%), neck pain with movement coordination impairments (NPMCIs) (8%), and neck pain with headache (6%). Neck pain with movement coordination impairment had the lowest percentage of proper classifications. Classification accuracy was highest when subjective and objective findings were combined and varied between IBCs. Conclusion: Our findings suggest that physical therapists evaluating patients with neck pain may have increased classification accuracy when subjective and objective findings are considered. Decreased classification accuracy was demonstrated in the NPMCI category, highlighting opportunities for further education and research.

Efficacy of Transcutaneous Electrical Nerve Stimulation in Management of Cancer Pain: a Meta Analysis.

The present investigation assesses efficacy of transcutaneous electrical nerve stimulation (TENS) on relief of cancer or chemotherapy-related pain. Patients with cancer experience a relatively high prevalence of pain that is reportedly undertreated. Therefore, this analysis is pertinent to determine if TENS is a useful complementary therapy considering its increase in accessibility and minimal side effect profile. A systematic search for eligible studies from PubMed, Google Scholar, Cochrane, and Embase was performed. The present investigation elucidated any significant differences between change in numeric rating scale of average and maximum pain scores between a TENS and non-TENS group. A nonsignificant difference was reported between TENS and non-TENS, with a mean difference of - 0.393 (95% CI - 1.780, 0.993; P = 0.578). For change in maximum pain reported, a nonsignificant difference was also found, with a mean difference of 0.128 (95% CI - 1.158, 1.414; P = 0.845). Related to various limitations of this meta-analysis, no definitive conclusions could be concluded regarding efficacy of TENS in the treatment of cancer or chemotherapy-related pain. Additional randomized primary studies with standardized treatment protocols and pain measurements are needed for future meta-analysis and recommendations for clinical practice.

Asymptomatic Hyperuricemia and the Kidney: Lessons from the URRAH Study.

Chronic kidney disease (CKD) is a prevalent global health concern affecting approximately 850 million people worldwide, with a significant and rising mortality rate. CKD often coexists with hyperuricemia (HSUA), which is also increasingly common due to its association with hypertension, obesity, and diabetes. The interplay between hyperuricemia and CKD is complex; while in vitro studies and animal models support a role for uric acid mediating glomerular and tubule-interstitial damage, and HSUA has been shown to predict the onset and progression of CKD, the expectations of renal protection by the use of urate lowering treatment (ULT) are inconsistent. A significant challenge in managing asymptomatic HSUA in CKD patients lies in determining the appropriate SUA threshold values. Recent research, including the URRAH project, has sought to identify SUA cut-offs predictive of cardiovascular mortality, but these thresholds may vary depending on the severity of CKD. This variability complicates the establishment of universal guidelines for treating asymptomatic HSUA, leading to a lack of specific recommendations in clinical practice. In conclusion, while hyperuricemia is recognized as a prognostic factor for CKD and cardiovascular risk, more research is needed to refine the threshold values for SUA and to identify which patients may benefit from ULT. Stratification based on glomerular filtration rate may be necessary to tailor the treatments and improve outcomes in this population.

Hypertrophic cardiomyopathy management: a systematic review of the clinical practice guidelines and recommendations

Hypertrophic cardiomyopathy management: a systematic review of the clinical practice guidelines and recommendations

Bile acid diarrhea in patients with chronic diarrhea. Current appraisal and recommendations for clinical practice.

Bile Acid Diarrhea (BAD) is a common cause of chronic diarrhea, often accompanied by urgency, occasional fecal incontinence, abdominal pain, and fatigue. A nationwide survey has shown limited awareness of BAD within the Italian medical community, prompting a panel of experts to develop a Position Paper that outlines the most practical and cost-saving diagnostic investigations and treatments for this frequently overlooked condition. The document provides an overview of the epidemiology, pathophysiology, clinical manifestations, and classification of the different types of Bile Acid Diarrhea (BAD). A key focus is the diagnostic approach to identifying and managing the many undiagnosed BAD patients in both primary care and specialized medical settings. Finally, the paper addresses the optimal therapeutic strategies for BAD, including traditional bile acid sequestrants and newer, promising treatments.

The etiology of attention deficit disorder with hyperactivity: A protocol for an umbrella review.

Attention deficit hyperactivity disorder (ADHD) is one of the common neurodevelopmental disorders and is widely prevalent worldwide. The primary symptoms of ADHD include inattention, impulsivity, and hyperactivity, which significantly impact the cognitive, behavioral, and emotional dimensions of individuals. These disorders often continue throughout adulthood and, along with associated complications, affect various domains such as personal health, academic achievement, and social interactions. The pathogenesis and contributing causes of ADHD remain unclear at present. Therefore, this study aims to perform an umbrella review of systematic reviews and meta-analyses (SRMAs) to systematically assess the quality of methodologies, potential biases, and validity of all epidemiological evidence related to risk factors for ADHD while offering a comprehensive summary of the evidence regarding these risk factors. This study follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and Cochrane Handbook. We will systematically search 6 databases, including The Cochrane Library Central, PubMed, Embase, Web of Science, CINAHL, and Scopus from the initial period up until 2024 (last update). We will assess the quality of the included SRMAs using the tool to assess risk of bias in systematic reviews (ROBIS), the methodological quality of systematic reviews (AMSTAR)-2, PRISMA-2020, and the grade of recommendations assessment, development and evaluation (GRADE). Two authors will use the ecological models of health behavior to classify the causes and risk factors of ADHD. Finally, we will provide descriptive and comprehensive recommendations for clinical practice and future research. PROSPERO (CRD42024597126).

Saudi National Clinical Practice Guidelines for Management of Adult Systemic Lupus Erythematosus.

To provide evidence-based clinical practice recommendations for managing Systemic Lupus Erythematosus (SLE) in Saudi Arabia. This EULAR-adapted national guideline in which a multidisciplinary task force utilized the modified Delphi method to develop 31 clinical key questions. A systematic literature review was conducted to update the evidence since the EULAR publication. After reaching a consensus agreement, two rounds of voting and group discussion were conducted to generate consolidated recommendations/statements. A significant number of patients in Saudi Arabia experience delays in accessing rheumatologists, highlighting the significance of timely referral to SLE specialists or rheumatologists to ensure accurate diagnosis and prompt treatment. The primary goal of Glucocorticoid (GC) therapy in SLE patients is to establish disease control with a minimum dose and duration. Steroid-sparing agent utilization facilitates steroid-sparing goals. Hydroxychloroquine is recommended for all SLE patients, though physicians must carefully monitor toxicity and prioritize regular medication adherence assessment. SLE management during pregnancy starts from preconception time by assessing disease activity, major organ involvement, hypercoagulability status, and concomitant diseases that may negatively impact maternal and fetal outcomes. Multidisciplinary care with close monitoring may optimize both maternal and fetal outcomes. For patients with antiphospholipid antibodies, low-dose aspirin prophylaxis is recommended. Also, Long-term anticoagulant medications are fundamental to prevent secondary antiphospholipid syndrome due to high thrombosis recurrence. This Saudi National Clinical Practice guidelines for SLE management provide evidence-based recommendations and guidance for healthcare providers in Saudi Arabia who are managing patients with SLE. These guidelines will help to standardize healthcare service, improve provider education, and perhaps lead to better treatment outcomes for SLE patients.

ASSOCIATION BETWEEN GUT MICROBIOTA, DIET, AND COGNITION IN ELDERLY PATIENTS WITH MILD COGNITIVE IMPAIRMENT

Abstract Objectives To compare the gut microbiota in individuals with mild cognitive impairment (MCI) and normal controls (NCs) and explore the association between dietary intake and various cognitive domains across identified enterotypes, providing a basis for dietary interventions based on the Microbiota-Gut-Brain Axis. Methods We analyzed fecal samples and 16S ribosomal RNA sequences for microbiota among 100 participants (NCs: 50, MCI: 50). Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and Auditory Verbal Learning Test (AVLT). A semi-quantitative food frequency questionnaire was used to assess participants’ dietary intake, and differences in dietary habits and cognitive function among distinct enterotypes were analyzed. Results Participants with MCI exhibited lower bacterial richness. Linear Discriminant Analysis of Effect Sizes (LEfSe-LDA) revealed different major microbial genera between the groups, and a random forest model based on dominant bacterial genera could distinguish between MCI and NCs (AUC=0.743, 95%CI:0.646-0.840). Cluster analysis identified two enterotypes: Escherichia-Shigella (enterotype E) and Bacteroides (enterotype B). When grouped by enterotypes, similar dietary intake was associated with different cognitive domains: notably, egg intake positively correlated with MOCA and AVLT scores for enterotype E, but not for enterotype B. Conclusions: Significant differences exist in the gut microbiota of individuals with MCI compared to those with normal cognition, with dominant genera showing good predictive performance. The impact of different enterotypes on the relationship between dietary intake and cognitive function should be considered when making dietary recommendations in clinical practice.

IPNA clinical practice recommendations on care of pediatric patients with pre-existing kidney disease during seasonal outbreak of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic, instigated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has profoundly impacted healthcare infrastructures around the globe. While children are usually asymptomatic or have mild symptoms, children with pre-existing kidney conditions require specialized attention. This pivotal report, championed by the International Pediatric Nephrology Association (IPNA), delivers precise and actionable recommendations tailored for pediatric patients with kidney ailments in this pandemic landscape. Central to our findings are rigorous infection control protocols. These are particularly stringent in high-risk zones, emphasizing telehealth's indispensable role, the significance of curtailing in-person consultations, and the imperative of following rigorous guidelines in regions with heightened COVID-19 prevalence. Additionally, the report delves into vaccination approaches for children with kidney issues, highlighting that the choice of vaccine is often governed by regional accessibility and policy frameworks, rather than a universal preference. A notable observation is the potential correlation between COVID-19 vaccines and specific kidney disorders. However, establishing a direct causal link remains elusive. In summary, our research accentuates the critical need for specialized pediatric kidney care during global health crises and reaffirms the continuous research imperative, especially regarding vaccination ramifications.

Syphilitic aortitis: from the past to the present (view of a dermatovenerologist)

In order to improve the diagnosis and treatment of syphilitic aortitis, an analysis of known data on the clinical manifestations, course and diagnosis of this pathology was conducted, illustrating our own observations with the subsequent implementation of recommendations in clinical practice. The problem of syphilitic aortitis - the most frequent manifestation of late syphilis - was considered. Current data on clinical manifestations, possibilities and problems of diagnosing this pathology were presented. Modern methods of serological research used in the diagnosis of syphilitic aortitis were analyzed in detail; the course, complications and prognosis of this pathology were separately considered. All these aspects were illustrated by our own observations of clinical cases of syphilitic aortitis, which are of interest due to their rarity in clinical practice and demonstrate the importance of correct diagnosis and appropriate treatment. Serological tests for syphilis, ultrasound examination of the heart, extracardiac vessels and internal organs; X-ray examinations were used when examining patients. It was concluded that lesions of the cardiovascular system are currently among the most common forms of visceral syphilis. Syphilitic aortitis with symptoms of cardiovascular damage, which are caused by aortic valve insufficiency, narrowing of the ascending coronary arteries, aneurysmal dilatation of the ascending part and aortic arch, occurs in the late stages of syphilitic infection. Even in patients with syphilis who have been treated in the past with penicillin drugs, cardiovascular damage may occur, namely aortitis with aortic valve insufficiency. The most informative methods for detecting late cardiovascular damage are: enzyme-linked immunosorbent assay, passive hemagglutination reaction, immunoblotting and computed tomography of the heart and echocardiography. Special attention is paid to the fact that the uniqueness of the above observations lies in the fact that complicated forms of aortitis began to occur more often and also in treated syphilis patients who had previously been treated with water-soluble penicillin. Aortitis also occurs against the background of seroconversion (positivity) of non-treponemal tests, which were previously negative after treatment.