Pediatric Group Research Articles

Childhood brainstem lesions

Brainstem gliomas are more common in the paediatric age group as compared to adults. They have variable clinical presentations, which can range from mild to severe. Radiographic appearance on MRI, anatomical location, and molecular pathology plays a key role in management and prognostication. A multidisciplinary approach based upon the extent and type of tumour is followed. In our study, we have reported 3 such cases who presented in different ways and were diagnosed as brainstem glioma. We have also discussed various modalities of investigation and management.

Gastric volvulus in children: diagnosis and treatment approaches

Gastric volvulus is a sporadic disease in the pediatric age group and is very complex in terms of etiology and management. In this study, we aimed to discuss two late-diagnosed gastric volvulus cases, review the diagnosis and treatment methods of gastric volvulus cases in the pediatric age group encountered in the literature, and reduce concerns about the correct diagnostic approach to these cases. The first case was an 8-year-old girl who was followed up due to developmental delay and metabolic disease and was admitted due to recurrent vomiting attacks. The endoscopic reduction was first performed on the patient whose upper gastrointestinal tract imaging was compatible with organoaxial gastric volvulus. Since vomiting attacks continued, laparoscopic gastropexy was performed. In the postoperative follow-up, there was weight gain and vomiting complaints wholly regressed. The second case was a 1-year-old girl who was treated for gastroesophageal reflux at an external center due to vomiting and developmental delay, but she did not receive any response. The endoscopic reduction was performed because the patient's upper gastrointestinal imaging was compatible with the organoaxial gastric volvulus. Laparoscopic gastropexy was performed on the patient whose vomiting recurred. The stomach was expected to be seen in the upper passage imaging in the postoperative period. In the systematic search made in the MEDLINE/Pubmed database using the keywords "gastric volvulus and pediatric," 41 literature articles presenting 47 cases between 2013 and 2023 were included. The patient's age, gender, complaints at admission, type of gastric volvulus, and treatment-related data were collected. The most common symptoms in the patients were vomiting, and abdominal pain and the most common comorbidities were diaphragmatic pathologies and wandering spleen. The most preferred treatment was anterior gastropexy. Gastric volvulus is characterized by vomiting, abdominal pain, and developmental delay. It is tough to diagnose, especially in chronic cases. In addition to the conservative approach in chronic cases, anterior gastropexy should be preferred to prevent recurrent volvulus attacks.

Examination of the transport characteristics of pediatric trauma patients.

Injury is an important public health problem in the pediatric age group and one of the leading global causes of morbidity and mortality. The fact that pediatric trauma has a significant impact on patients, families, and countries shows the need for a better understanding of this phenomenon. This study investigates the demographic characteristics, reasons for admission to the hospital, and diagnoses of pediatric trauma patients who received prehospital emergency health services. This study was designed as a retrospective observational study and included all patients under the age of 18 who received emergency healthcare due to trauma and were registered in the Emergency Health Automation System after a call was placed to the emergency call center between 1 January 2018 and 31 December 2022. Information such as the reason for calling an ambulance, ICD-10 diagnosis codes, mechanism of injury, time of arrival at the scene, transport duration from the scene to the hospital, and reasons for interfacility transfers were collected for all patients. A total of 37,420 patients were included in the analysis. Seventeen patients were found dead at the scene of the trauma and 35 patients experienced cardiac arrest on the way to the hospital from the scene. The difference between age groups in terms of time from arrival at the scene to arrival at the hospital was statistically significant (p < 0.001). Falls were the most common cause of trauma in all age groups, followed by traffic accidents. Patients requiring a specialist and transferred primarily for fall-related injuries were in direct proportion to the total number of cases (65.0%, n = 1838), followed by cases of traffic accidents and sports injuries. Most of the secondary transports were made to a training and research hospital or state hospital. Targeted preventive measures and community education should address the specific causes of trauma that are more prevalent in certain age groups. Early identification of special patient groups that typically require secondary transport can reduce mortality and morbidity related to trauma by facilitating direct transfers to appropriate hospitals.

Liver transplantation for pediatric liver malignancies.

In the last few decades, collaboration between the international pediatric oncology groups has resulted in significant improvement in survival after liver transplantation (LT) for pediatric liver tumors, and LT has become the accepted standard of care for unresectable pediatric liver tumors - either living donor liver transplantation (LDLT) or deceased donor liver transplantation (DDLT). Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the common pediatric liver malignancies treated by LT, and LT is now the accepted treatment modality for unresectable non-metastatic cases. The long-term survival rate is more than 80% in HB transplants. Furthermore, with the advent of LDLT, the waitlist mortality, availability of a better graft quality with shorter ischemic times, and performance of LT with the appropriate timing between chemotherapy have all improved. Up to 80% of pediatric HCCs are unresectable, and studies have shown that LT for pediatric HCC has better outcomes than liver resection. Furthermore, LT has also shown better results than liver resection for cases of HCC not meeting Milan criteria. Given the rarity of pediatric liver malignancies and challenges in optimal management, a multidisciplinary treatment approach, research models building on what is already known, and consideration of newer treatment modalities are required for further improving the treatment of pediatric liver malignancies.

The role of reticulocyte hemoglobin equivalent on the evaluation of iron deficiency and iron deficiency anemia in pediatric cyanotic heart disease: a diagnostic study in Indonesia

BackgroundIn light of prolonged hypoxia, children with cyanotic heart disase (CHD) are at a high risk of developing iron deficiency iron deficiency (ID) and iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is a novel and dependable indicator for assessing iron status. However, there has been no previous study regarding cut-off value in pediatric CHD group. The purpose of this study is to assess the role of Ret-He and to establish cut-off points in the diagnosis of iron deficiency and IDA in pediatric cyanotic heart disease.MethodThis study was conducted in two tertiary hospitals in Jakarta, Indonesia. 59 children with CHD, aged 3 months to 18 years, were enrolled consecutively. To determine iron status, hematological parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin) and biochemical parameters for iron status (serum ferritin, transferrin saturation) were analysed and compared to Ret-He levels. The receiver operating characteristic (ROC) analysis was performed for the Ret-He cut-off points for ID and IDA. Sensitivity, specificity, positive and negative predictive value were calculated for each cut-off point.ResultNormal iron status was identified in 27 (45.8%) subjects, ID in 8 (13.5%) subjects, and IDA 24 (40.7%) subjects. The ID cut-off value for Ret-He is 28.8 pg (sensitivity 75%, specificity 85.2%, PPV 60%, NPV 92%, and AUC 0.828) and the Ret-He cut-off point for IDA is 28.15 pg (sensitivity 75%, specificity 88.9%, PPV 85.7%, NPV 80%, and AUC 0.824). Hemoglobin should be used in conjunction with Ret-He. ID might be detected in this cohort with Ret-He 28.8 pg and hemoglobin > 16,5 g/dL. While Ret-He 28.15 pg or Ret-He 28.15–28.8 pg with hemoglobin 16.5 g/dL could be used to diagnose IDA.ConclusionThe reticulocyte hemolgobin equivalent could be utilised as an iron status parameter in pediatric CHD, with a cut-off value of 28.8 pg for ID and 28.15 pg for IDA.

Insulin-Related Suicide Attempt in Non-Diabetic Pediatric Patient

Insulin analogs are basic drugs that are widely used in the treatment of diabetes around the world. Suicides with their use are described as rare, occurring mainly in the population of diabetic patients due to their easy access to the drug and knowledge of its properties. Among non-diabetic people, insulin is used for suicidal purposes mainly by adults with medical education. A case of a 15-year-old girl found unconscious by her mother at night was described. The patient was immediately transported to the hospital, where she was diagnosed with her first severe hypoglycemic episode of unknown origin. Once conscious and in a better state, the patient admitted to having taken insulin, which she had stolen from her diabetic mother, for suicidal purposes. The patient had no history of mental illness or self-destructive behavior. The patient was referred to psychiatric care. Suicides and suicide attempts involving insulin are usually observed among people with chronic diabetes. Moreover, such attempts are made by adults who know the mechanism of action of the drug. In the pediatric group without diabetes, such cases are extremely rare. Additionally, the issue of similar behaviors becomes very important due to the increasing popularity and availability of insulin therapy and the possibilities of obtaining information about using it to commit suicide from the Internet. Particular vigilance is required in pediatric emergency departments when a patient is identified as having a first episode of severe hypoglycemia of unknown origin.

Imaging panorama of pediatric central nervous system tuberculosis.

Central nervous system tuberculosis (CNS TB) is the most dreaded manifestation of systemic tuberculosis in the pediatric age group. It is associated with high morbidity and mortality due to severe neurological complications and sequelae. Knowledge about the imaging spectrum of CNS TB will help in early presumptive diagnosis and prompt treatment, reducing the development of complications. Imaging also plays a vital role in monitoring the progression of disease after the initiation of antituberculosis therapy. Advanced magnetic resonance imaging (MRI) techniques have recently improved the diagnostic efficacy manifold.In this review, we describe the imaging characteristics, the role of advanced imaging techniques, and follow-up imaging in various types of CNS TB in the pediatric population.

Antibiotic susceptibility pattern among children admitted to a hospital in Nigeria: A retrospective study.

The impact of antimicrobial resistance on children living in resource-limited countries has been underreported, despite its established global threat. This retrospective study aimed to describe the trend of antibiotic susceptibility in the paediatric age group. Sensitivity test report data consisting of 300 paediatric patients aged 18 hours to 192 months were retrieved from the microbiology laboratory records at a state-owned children's hospital in Nigeria over a period of 4 months starting from December 2021 to March 2022. Five genera (Escherichia coli, Klebsiella spp., Pseudomonas spp., Staphylococcus aureus and Streptococcus spp.) were cultured as recommended by the Clinical Laboratory Standard Institute, using the Kirby Bauer disc diffusion method. Antimicrobial susceptibility testing was carried out on isolates using 15 different antibiotics. Staphylococcus aureus was the most frequent pathogen isolated 32.1% (50/156) and Pseudomonas spp. was the least frequent pathogen isolated 7.1% (11/156) in all samples. The isolates with the highest rate of resistance to the tested antibiotics were S. aureus 32.1% (50/156), E. coli 28.2% (44/156) and Klebsiella spp. 20.5% (32/156). Isolates in all age groups were more resistant to ampicillin, amoxicillin + clavulanic acid, cefuroxime and cefepime. Antibiotic resistance is high, especially the younger Nigerian children. Strict antibiotic protocols should be adhered to especially in the use of empirical antibiotic therapy in hospitals. Our study reveals a higher trend of antibiotic resistance, especially in younger children. It further shows that the pathogens are most resistant to the most available empirical antibiotics in Nigeria.

Characteristics and outcomes of children, adolescent, and young adult patients with myelodysplastic neoplasms: A single-center retrospective analysis

Myelodysplastic syndrome, or myelodysplastic neoplasms, are a rare finding in pediatric, adolescent, and young adult (AYA) patients. More literature is needed to highlight trends of survival or treatment resistance in subpopulations to improve treatment. Here we report a single center retrospective analysis of pediatric and AYA patients from 2000 to 2022 including molecular and cytogenetic data. Using the IPSS-R and IPSS-M, which have been reported exclusively in adults, and excluding patients with bone marrow failure syndromes, we analyzed 119 pediatric and AYA patients with myelodysplastic neoplasms. Therapy-related myelodysplastic neoplasms were present in 36 % of patients, and 31 % of patients developed acute myeloid leukemia. The 5-year overall survival (OS) rate for the entire cohort was 45 %. Contrary to young adults and older adults, mutations were not common in pediatrics. Those who underwent stem cell transplant (SCT)(at any time) had significantly longer median OS. Although SCT at any time improved OS in the de novo myelodysplastic neoplasm group, the choice of the initial treatment with intensive chemotherapy, hypomethylating agents, or SCT did not significantly alter OS. Median OS was shorter in the pediatric group (<18 years old) and longer for those with isolated deletion of 5q or TET2 mutation, but these were not significant findings. Median OS was significantly shorter in those with monosomy 7 or 7q deletion and those with therapy-related myelodysplastic neoplasms. These findings build on previously reported findings and encourage the use of SCT along with molecular and cytogenetic analysis.

Influenza Vaccination Coverage in Children: How Has COVID-19 Influenced It? A Review of Five Seasons (2018-2023) in Central Catalonia, Spain.

Influenza vaccination is the main method of preventing influenza. Vaccination is recommended for certain individuals with diseases that could cause complications in the case of flu infection. The objective of this retrospective observational study was to examine influenza vaccination coverage in patients with risk factors, to describe the characteristics of those vaccinated and to study the influence of COVID-19. The study population was children under 14 years old with risk factors between 2018/19 and 2022/23 in Central Catalonia, sourced through the electronic database of the Catalan Institute of Health. The association of influenza vaccination data with sociodemographic data and risk factors was performed by bivariate and multivariate analysis. A total of 13,137 children were studied. Of those, 4623 had received the influenza vaccine in at least one season. The average influenza vaccination rate was 28.8%. The statistically significant factors associated with vaccination were age and having certain risk factors: asthma, diabetes, haemoglobinopathies and clotting disorders. In all seasons, the immigrant population was vaccinated more than the native population p < 0.05, except for the COVID-19 season (2020/21), where no differences were observed. Of those vaccinated, 7.1% had been vaccinated for 5 consecutive years. Influenza vaccination coverage in the paediatric age group was low. Vaccination promotion measures must be implemented. COVID-19 meant an increase in vaccination of the native population to the same level as that of the immigrant population.

Hospital-Acquired Bloodstream Infections in the Adult Intensive Care Unit at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia.

Introduction Hospital-acquired infections, also called nosocomial infections, are infectious diseases acquired in healthcare facilities at least 48 hours after admission and can't be present at the time of admission. Nosocomial bloodstream infection is a serious medical complication from hospitalization, and it can be potentially preventable by taking certain precautions. Aim The aim of this study is to determine the prevalence of central line-related bloodstream infections (CLABSI) with different organisms between January 2022 and February 2024 at the intensive care unit (ICU) at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia. Patients and methods This retrospective cross-sectional study was conducted among ICU adult patients. The data were collected from medical and infection control records. All data for intensive care patients with positive blood cultures, except for the pediatric age group, were collected. Data were tabulated and cleaned in MS Excel, and subsequent data analyses were performed in IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results Data from 21 patients were collected and analyzed. The mean age of the participants was 62.9 (SD 15.1) years.Femaleparticipants (61.9% (13)) were higher than males(38.1% (8)). All patients were inserted with a non-tunneled central venous catheter (CVC). The mortality rate was 76.2% (16). Vancomycin-resistant enterococci (VRE) was the most commonly detected organism in seven cultures(33.3%), followed by Candida species in six cultures(28.6%). Candida species were prevalent in younger patients (p=0.021) and those sensitive to medication (p=0.015). Survival analyses between age, gender, and organisms yielded insignificant results (p>0.05). Conclusion The major sources of bloodstream infection among adult ICU patients were VRE and Candida species. Mortality was common in this population, particularly among patients who were resistant to medication. Hence, strategies to reduce hospital-acquired bloodstream infections are warranted.

Population Pharmacokinetics (PopPK) Support for Pediatric Dosing of Biological Products.

This study assesses the use of population pharmacokinetics (PopPK) in supporting pediatric dosing of novel biological drug products. The labeling for biologic drug products approved by the US Food and Drug Administration (FDA) from 2002 until 2021 was reviewed to identify those with a pediatric indication. For the drugs with a pediatric indication, the dosing regimen(s) based on age groups, dosing strategy, the use of PopPK to support the dose, and the types of pediatric clinical trials were reviewed. Data were collected from FDA's review documents and product labels on the Drugs@FDA website, and as needed, more clinical trial details were collected from PubMed and clinicaltrials.gov. The role of PopPK analyses in dosing was captured when mentioned in the label or review as playing a role in selecting the approved pediatric dose and/or in verifying the adequacy of the studied dose to support labeling. Between 2002 and 2021, FDA approved 169 biological products, and 78 of 169 (46%) products have an approved indication for which the label contains dosing recommendations for pediatric use. For the 78 products approved in pediatrics, there was a total of 180 clinical trials that included pediatric patients. Phase 3 pediatric trials commonly supported pediatric approval and dosing for the reviewed products (64%, 50/78 products; 56.1%, 101/180 trials). PopPK analyses were reported to play a critical role in dose selection, prediction, and verification for 40 of the 78 products (51%), including informing pediatric dosing in the absence of pediatric data (e.g., drugs approved under animal rule), comparing exposures to the exposure range observed in adults, and informing alternative dosing strategies in certain age or body weight groups. PopPK analyses have been applied in a variety of ways to inform pediatric dosing and support extrapolation from adult data or other pediatric age groups for biologics. Understanding and learning from these past cases on the use of pharmacometrics tools to support pediatric dosing of biological products can inform future pediatric development programs.

Burden of Disease Due to Respiratory Syncytial Virus in Adults in Five Middle-Income Countries.

Respiratory syncytial virus (RSV) is an important cause of severe respiratory disease in older adults. Understanding the disease burden is crucial for guiding vaccination policy and raising disease awareness. We estimated the burden of RSV hospitalizations and deaths in adults in five middle-income countries: Argentina, Brazil, Chile, Mexico, and Malaysia. Hospital discharge and death statistics due to any respiratory disease (ICD-10 codes: J00-99) from 2010 to 2022 were obtained. The RSV attributable burden on hospitalizations and deaths by age group was determined for 2019 using previously published estimates. Latin American countries showed distinct annual peaks in respiratory-related hospitalizations and deaths during winter months that were absent in Malaysia. Among ≥20-year-olds in 2019, there were 14,604 RSV-attributable hospitalizations nationally in Argentina, 44,323 in Brazil, 4529 in Chile, 7416 in Malaysia, and 8651 in Mexico, and 60-74% in ≥65-year-olds. There were also 3518 RSV-attributable deaths in Argentina, 9115 in Brazil, 801 in Chile, 704 in Malaysia, and 3806 in Mexico 79-88% in ≥65-year-olds. Incidences of RSV-attributable hospitalizations in ≥75-year-olds ranged between 256.3 and 294.3 per 100,000 population, and deaths between 33.6 and 112.9 per 100,000 population. RSV is associated with a substantial disease burden beyond pediatric age groups, and preventive vaccines could have a major impact on this burden, especially in older adults.

Treatment initiation in FH paediatric patients – 1-year follow-up data from the LIPIGEN paediatric group

Treatment initiation in FH paediatric patients – 1-year follow-up data from the LIPIGEN paediatric group

Rare presentation of Omental Cyst in Inguinal Hernia

Introduction: Inguinal hernia is one of the most frequent surgery performed by pediatric surgeons and majority of the hernias are indirect inguinal hernia. Mostly the sac is empty or might contain omentun , small bowel , ovaries , fallopian tubes etc. Rarely we see patients in which sac contains huge cystic lesion. We present a case report of patient who presented to us with swelling in left inguinal region and a preiminalry diagnosis of Left inguinal hernia was made later on it was found that the hernia sac contains a huge omental cyst which remained un-diagnosed till the time of surgey. Omental cyst is one of the rarest types of intraabdominal cystic lesions in pediatric age group.

Impact of Rituximab on Remission Rates in Granulomatosis With Polyangiitis: A Systematic Review.

This systematic review evaluates the efficacy of rituximab in inducing and maintaining remission in patients with granulomatosis with polyangiitis (GPA). We conducted a comprehensive search across multiple databases, identifying 81 studies, of which 11 met our inclusion criteria after rigorous screening and assessment for relevance and quality. Our analysis shows that rituximab, compared to traditional treatments such as cyclophosphamide and azathioprine, significantly improves remission rates and reduces relapse frequency in GPA patients. Notably, rituximab's benefits extend across various patient demographics, including pediatric groups, and are evident in different dosing regimens, highlighting its versatility and potential as a first-line therapy. The review also underscores the importance of personalized medicine approaches in managing GPA, as rituximab's effectiveness was particularly pronounced in patients with relapsing disease forms. Future research should focus on long-term outcomes, optimal dosing strategies, and the economic implications of widespread rituximab use in clinical practice. Our findings advocate for the integration of rituximab into standard treatment protocols for GPA, offering new hope for patients afflicted with this challenging autoimmune disorder.

Biochemical Side Effect of Antiepileptic Drugs on Liver Enzymes, Lipid Profile and Haematological Profile in Epileptic Pediatric Patients

Antiepileptic drugs are large group of medications with variable mechanisms of action. There are various effects have been reported with long-term antiepileptic therapy. To assess the effects of the antiepileptic drugs on blood indices, liver function and lipid enzymes in epileptic pediatric age group. A comparative case-control study was performed in which 50 epilepsy cases were matched with 50 controls for age and sex. The mean age of the cases was 9.1(± 3.7) years, 86% from Benghazi. The 68% were primarily generalized seizure, 64% tonic clonic convulsion. The age at diagnosis between 2 months - 13 years. The 74% used Na-valproate as a single or a combined therapy and Carbamazepine was prescribed as a single medication in 18%. No statistical significant differences in the means of CBC indices and liver function profiles (AST and ALT) in the treatment groups compared to the control. Alkaline phosphatise was highly significant difference in the mean between the two groups (P=0.007). Mean of serum Cholesterol level showed higher in the cases than controls with highly statistical significant difference (P&lt;0.001). HDL mean level is higher for cases on carbamazepine and Na-valproate group compared to controls with statistical significant difference (P=0.011). Cases on carbamazepine and Na-valproate group as well showed higher mean LDL level compared to the controls with statistically significant (P=0.006). No any statistical significant difference in means of CBC indices between epileptic patient treated with AED and control. Carbamazepine group expressed higher mean HDL level as compared to Na-valproate group, this difference is highly significant. Key words: Antiepileptic drugs, liver enzymes, lipid profiles.

Long COVID in Children and Adolescents: A Critical Review.

(1) Background: Data on persisting symptoms after SARS-CoV-2 infection in children and adolescents are conflicting. Due to the absence of a clear pathophysiological correlate and a definitive diagnostic test, the diagnosis of Long COVID currently rests on consensus definitions only. This review aims to summarise the evidence regarding Long COVID in children and adolescents, incorporating the latest studies on this topic. (2) Methods: We designed a comprehensive search strategy to capture all relevant publications using Medline via the PubMed interface, with the initial literature search conducted in April 2023. To be included, publications had to present original data and include >50 participants with Long COVID symptoms aged between 0 and18 years. (3) Results: A total of 51 studies met the inclusion criteria, with most studies originating from Europe (n = 34; 66.7%), followed by the Americas (n = 8; 15.7%) and Asia (n = 7; 13.7%). Various study designs were employed, including retrospective, cross-sectional, prospective, or ambispective approaches. Study sizes varied significantly, with 18/51 studies having fewer than 500 participants. Many studies had methodological limitations: 23/51 (45.1%) studies did not include a control group without prior COVID-19 infection. Additionally, a considerable number of papers (33/51; 64.7%) did not include a clear definition of Long COVID. Other limitations included the lack of PCR- or serology-based confirmation of SARS-CoV-2 infection in the study group. Across different studies, there was high variability in the reported prevalence of Long COVID symptoms, ranging from 0.3% to 66.5%, with the majority of studies included in this review reporting prevalences of approximately 10-30%. Notably, the two studies with the highest prevalences also reported very high prevalences of Long COVID symptoms in the control group. There was a relatively consistent trend for Long COVID prevalence to decline substantially over time. The prevalence of Long COVID appeared to differ across different paediatric age groups, with teenagers being more commonly affected than younger children. Furthermore, data suggest that children and adolescents are less commonly affected by Long COVID compared to adults. In children and adolescents, Long COVID is associated with a very broad range of symptoms and signs affecting almost every organ system, with the respiratory, cardiovascular, and neuropsychiatric systems being most commonly affected. (4) Conclusions: The heterogeneity and limitations of published studies on Long COVID in children and adolescents complicate the interpretation of the existing data. Future studies should be rigorously designed to address unanswered questions regarding this complex disease.

Comparison of Histomorphological Indices Between Adult and Pediatric Patients in Response to Induction Therapy.

Renal involvement, known as lupus nephritis (LN), is a common and serious complication of systemic lupus erythematosus (SLE), linked to significant morbidity and mortality. Histomorphological indices, such as the activity index (AI) and chronicity index (CI), are critical in predicting treatment responses and outcomes. This study aims to compare these histomorphological indices between adult and pediatric patients with LN and evaluate their impact on post-induction therapy outcomes. A cross-sectional analysis was conducted at a single nephrology department from 2005 to 2019, including patients with biopsy-confirmed LN. Data on demographic characteristics, histomorphological indices, and clinical outcomes post-induction therapy were collected. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States) to identify significant correlations and differences. Pediatric patients exhibited significantly lower AI (p=0.042) and CI scores compared to adults. Lower frequencies of hyaline thrombi (p=0.005) and tubular atrophy (p=0.028) were observed in the pediatric group. Key predictors of a complete response to induction therapy included interstitial inflammation <0.65 and tubular atrophy <0.63. Significant correlations were found between post-induction renal function tests (RFT) and indices such as AI (p=0.035), CI (p<0.001), cellular and fibrocellular crescents (p<0.001), and tubular atrophy (p<0.001). Proteinuria outcomes were significantly associated with CI (p=0.040), interstitial inflammation (p=0.006), and tubular atrophy (p=0.026). The conclusion aligns with the established understanding that pediatric patients with LN often have a different disease trajectory compared to adults. Pediatric patients generally presented with less severe histomorphological damage, contributing to better responses to induction therapy. Detailed histopathological assessments are essential for guiding treatment strategies and improving patient prognosis in both adult and pediatric LN populations.

Collaborative data sharing: The International Acute Myeloid Leukemia Consortium (INTERACT).

169 Background: Outcomes for children and adolescents/young adults (AYAs) with acute myeloid leukemia (AML) remain suboptimal and are decidedly poor for patients with subtypes defined by high-risk features, including canonical genetic alterations and relapsed/refractory presentation. Due to their rarity, these subtypes are difficult to study within the existing clinical trials paradigm. Data sharing efforts aim to increase our understanding of rare cancer subtypes by pooling data from multiple sources. The INTERnational Acute myeloid leukemia ConsorTium (INTERACT) was established to pool and share data on pediatric and AYA patients with AML. Methods: In 2019, a data dictionary was created through an iterative, consensus-driven process that analyzed pre-existing clinical trials case report forms as the initial basis. By developing this standardized representation for data on patients with AML, data could be harmonized and integrated. A memorandum of understanding was signed in 2021, formally establishing INTERACT. An executive committee was convened to establish scientific priorities, facilitate ongoing data dictionary work, usher agreements with data contributors and review data requests submitted by investigators. In January 2024, the initial set of AML data was released on the Pediatric Cancer Data Commons (PCDC) data portal. Results: As of April 2024, the data dictionary includes 157 standardized data elements that were used to harmonize clinical data on 3,413 patients who participated in seven clinical trials conducted by four pediatric oncology cooperative groups across the United States, Europe, and Asia. Elements in the data dictionary include demographics, initial disease characteristics, genetic alterations, and survival status. Aggregate data can be freely explored using the publicly-available PCDC data portal (portal.pedscommons.org) and investigators seeking line-level access to data may submit a project request to the INTERACT executive committee for consideration. Conclusions: International collaborative data-sharing efforts will advance our understanding of pediatric and AYA AML by reducing barriers that constrain our study of AML to smaller cohorts of data. We hope that an early outcome of data sharing will be to increase our understanding of optimal treatments for patients with relapsed/refractory disease. Future goals of INTERACT include identifying data from additional studies to include, establishing relationships with new data contributors, and establishing working groups to advance the consortium’s scientific and clinical trials goals.