Effectiveness of Clown Intervention For Pain Relief In Children
Clown intervention may be a promising way to relieve acute pain in children, especially those aged 27 years.
KEY FINDINGS: Clown intervention may be a promising way to relieve acute pain in children, especially those aged 2–7 years. It also seems to shorten the duration of crying and the length of hospital stays, but the effect on cortisol levels is still uncertain. More high-quality randomised controlled trials are needed to confirm these results and take into account different age groups, cultural backgrounds and specific populations.
BACKGROUND: Pain is common in children receiving medical procedures, and there is a lack of adequate awareness and management. In addition, children who undergo medical procedures involving pain may also experience stress, crying and prolonged hospitalisation. Clown intervention is a promising nonpharmacological intervention. However, studies on the effectiveness of clown intervention in pain management have reported conflicting findings. Aim of this study is to evaluate the effectiveness of clown intervention in relieving pain in children, as well as its effects on cortisol levels, crying duration and length of hospital stay.
DETAILS: Two reviewers independently used the Cochrane risk of bias tool to assess the risk of bias of the included studies. Meta-analysis was conducted when data were available, otherwise, a narrative description was provided. Data were analysed using Review Manager 5.3. The review process is reported according to PRISMA. Nine studies including 852 children met the inclusion criteria. The results showed that compared with standard care, clown intervention was beneficial for relieving pain. Further subgroup analysis showed that it was more effective with children aged 2–7 years. The duration of crying after the procedure and the length of stay were shortened, but there was no significant difference in cortisol levels.
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Source: Ding, Y., Yin, H., Wang, S., et al. (2022). Effectiveness of Clown Intervention For Pain Relief In Children: A Systematic Review And Meta-Analysis. J Clin Nurs. 2022; 31(21-22): 3000-3310. Published: November, 2022. DOI: 10.1111/jocn.16195.
Longitudinal Analysis of Liver Chemistry Trajectories and Risk of Type 2 Diabetes in Children With Metabolic Dysfunction-Associated Steatotic Liver Disease
Longitudinal increases in GGT and AST are strongly associated with an elevated risk of incident type 2 diabetes in children with MASLD, highlighting their value as dynamic biomarkers of metabolic dysfunction. Systematic tracking of these markers could help clinicians identify high-risk children earlier, facilitating timely intervention to mitigate type 2 diabetes progression.
KEY FINDINGS: A 30-unit increase in GGT over time was associated with a substantially higher risk of developing type 2 diabetes in children with MASLD. Together with AST, GGT may provide clinicians with concrete, routinely available parameters to monitor for early risk stratification. Further validation in independent cohorts is needed to confirm these findings and inform clinical application.
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in children and is linked to type 2 diabetes. This study evaluates whether longitudinal changes in liver chemistries - γ-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) - can serve as biomarkers of increased type 2 diabetes risk in children with MASLD.
DETAILS: This multicenter longitudinal cohort study followed 1,035 children with biopsy-confirmed MASLD, without type 2 diabetes at baseline, for a mean of 3.9 years. Liver chemistries were measured annually, and type 2 diabetes was diagnosed based on fasting glucose, HbA1c, and clinical diagnosis. Extended Cox models with inverse probability weighting were used to evaluate associations between liver enzyme trajectories and type 2 diabetes risk. The cumulative incidence of type 2 diabetes was 12.3%. Increases in GGT (hazard ratio [HR] 1.55; 95% CI 1.34-1.80), AST (HR 1.31; 95% CI 1.20-1.43), and ALT (HR 1.13; 95% CI 1.07-1.20) were associated with a higher risk of developing type 2 diabetes in the independent models. In the mutual model with all three liver chemistries, only GGT and AST remained significant.
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Copyright © American Diabetes Association. All rights reserved.
Source: Thai, N. Q. N., Chun, L. F., Newton, K. P., et al. Longitudinal Analysis of Liver Chemistry Trajectories and Risk of Type 2 Diabetes in Children With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Multicenter Cohort Study. Diabetes Care . 2026; 598-606. 49(4): Published: April, 2026. DOI: 10.2337/dc25-1532
The Tissue Systems Pathology Test Predicts Risk of Progression in Patients With Barrett's Esophagus
Study demonstrated mean effect estimates for ORs and HRs that were consistent with previously published performance metrics for the TSP-9 test in individual studies, with minimal heterogeneity across studies from both common-effect and random-effects models.
Summary
Systematic Review and Meta-Analysis
[Posted 31/Mar/2026]
AUDIENCE: Gastroenterology, Internal Medicine
KEY FINDINGS: Effect estimates of TSP-9 performance demonstrate that the test provides risk stratification for BE patients. The TSP-9 test can provide clinically impactful results to enable escalation of care for high-risk patients or to identify low-risk patients who can be safely managed with routine surveillance.
BACKGROUND: A systematic review and meta-analysis of published clinical validity studies was conducted to evaluate the predictive performance of the TSP-9 test. Identifying patients with Barrett’s esophagus (BE) who will progress to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) is challenging. The tissue systems pathology (TSP-9) test can predict risk of progression to HGD/EAC in BE patients.
DETAILS: Databases were searched for studies that assessed the clinical validity of TSP-9, and data describing progressors, non-progressors, TSP-9 results, and hazard ratios (HR) with 95% confidence intervals (CIs) were extracted. Odds ratios (OR), sensitivity, specificity, and prevalence-adjusted positive and negative predictive values (PPVadj/NPVadj) were calculated and used for meta-analysis. Six studies met eligibility criteria, comprising 699 patients. ORs and HRs for TSP-9 had mean common effect size estimates of 6.52 (95% CI: 4.40-9.66, P<0.0001, I2=33%) and 6.66 (95% CI: 4.59-9.66, P<0.0001, I2=0%), respectively, for predicting progression to HGD/EAC. Mean common effect size estimates were 61% (95% CI: 54%-68%) for sensitivity, 81% (95% CI: 78%-84%) for specificity, 28% (95% CI: 17%-42%) for PPVadj (high risk), 14% (95% CI: 9%-21%) for PPVadj (high/int risk), and 97% (95% CI: 96%-98%) for NPVadj with minimal inter-study heterogeneity (I2=79%, 21%, 0%, 0%, and 0%, respectively).
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Copyright © Wolters Kluwer Health, Inc. All rights reserved.
Source: Houghton, C. C., Ditah, I., Leggett, C. L., et al. The Tissue Systems Pathology Test Predicts Risk of Progression in Patients With Barrett's Esophagus: Systematic Review and Meta-Analysis. Journal of Clinical Gastroenterology. 2026; 60(4)): 299-308. Published: April, 2026. DOI: 10.1097/MCG.0000000000002255
Clinical Characteristics, Management, and Hematopoietic Cell Transplantation of Patients With TLR8 Gain-of-Function
TLR8 GOF is an X-linked dominant disease that should be considered in both male and female patients with cytopenia and immune dysregulation. Patients with TLR8 GOF are refractory to medical management and should be considered for allogeneic HCT.
KEY FINDINGS: TLR8 GOF is an X-linked dominant disorder that should be considered in male and female patients with cytopenia, particularly severe neutropenia, lymphoproliferation with immune dysregulation, increased LGLs, and new to this cohort, red cell aplasia. Disease is refractory to medical management, and curative, allogeneic HCT should be considered early after diagnosis.
BACKGROUND: Toll-like receptor 8 (TLR8) gain-of-function (GOF) somatic variants were recently identified as causing severe neutropenia, lymphoproliferation, and immune dysregulation.
DETAILS: The expanded clinical and laboratory phenotype and management of 10 patients were reported, including the original cohort of 6 male patients. The first female patient was identified with TLR8 GOF who presented during infancy with pure red cell aplasia due to a germ line TLR8 variant, and 2 new disease-causing somatic variants in male patients. Eight patients had somatic mosaicism with peripheral blood variant allele fractions of 7% to 26%, and age of disease onset of 9 months to 28 years. All patients had neutropenia, most with severe neutropenia refractory to medical therapy. Anemia and thrombocytopenia were common. Bone marrow characteristically demonstrated severe myeloid hypoplasia and activated T-cell infiltrates and/or aggregates. An increased number of large granular lymphocytes (LGLs) was identified in 5 patients. Seven patients underwent allogeneic hematopoietic cell transplant (HCT). High rates of post-HCT cytopenia of unclear etiology and graft-versus-host disease were observed. Five patients are surviving at 1 to 3 years after HCT with full donor myeloid and T-cell chimerism, and resolution of disease phenotype. The 2 patients who presented during childhood and did not undergo HCT ultimately died from disease.
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Source: Arnold, D. E., Kaviany, S., Aluri, J., et al. Clinical Characteristics, Management, and Hematopoietic Cell Transplantation of Patients With TLR8 Gain-of-Function. Blood Adv. 2026; 10(6): 1967-1976. Published: March 24, 2026. DOI: 10.1182/bloodadvances.2025016338
Medications Not Dosed Within Recommended Range for Renal Function in Patients With Chronic Kidney Disease Identified upon Hospice Admission
Hospice-eligible patients frequently have renally cleared medications prescribed and at doses too high for their renal function. Analgesics, over-the-counter antihistamines, anticoagulants, anticholinergics have potential for significant adverse effects and higher vigilance is needed.
Summary
A Retrospective Chart Review
[Posted 5/Mar/2026]
AUDIENCE: Hospice & Palliative Nursing, Nephrology
KEY FINDINGS: Hospice-eligible patients frequently have renally cleared medications prescribed and at doses too high for their renal function. Analgesics, over-the-counter antihistamines, anticoagulants, anticholinergics have potential for significant adverse effects and higher vigilance is needed.
BACKGROUND: Hospice-eligible patients are vulnerable to adverse medication effects given their advanced illnesses and general older age. It is not known how often medications are not renal dose adjusted in hospice-eligible patients and which are frequently problematic. This study aims to identify commonly prescribed medications with significant renal clearance that are dosed too high and patient characteristics that increase the likelihood of occurrence.
DETAILS: This is a retrospective chart review of adult patients admitted to hospice care. Data collected included clinical/demographic data, renally cleared medications taken at time of hospice admission, and calculated renal function using several formulas. Descriptive statistics and binomial logistic regression were used to analyze data. Of 283 included charts, 27% had >=1 medication dosed too high for renal function. The most common medications prescribed and not renal dose adjusted included tramadol, gabapentin, duloxetine, loratadine, cetirizine, famotidine, apixaban, rivaroxaban, metformin, trospium, and most antimicrobials. Increasing serum creatinine values and increasing number of renally cleared medications were associated with a higher likelihood of a medication dosed too high [OR, 1.702, 95% CI (1.257, 2.305), P < 0.001] and [OR, 1.856, 95% CI (1.517, 2.271), P < 0.001] respectively. Residing at home vs a facility was associated with a reduced likelihood of having a medication dosed too high [OR, 0.30, 95% CI (0.134, 0.673), P = 0.003.].
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Source: Latuga, N. M. and Levy, K. Medications Not Dosed Within Recommended Range for Renal Function in Patients With Chronic Kidney Disease Identified upon Hospice Admission: A Retrospective Chart Review. American Journal of Hospice and Palliative Medicine. 2026; 43(3): 234-241. Published: March, 2026. DOI: 10.1177/10499091251323284.
Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy
Topical MB-mediated PDT successfully managed HPV-related FEH in an immunocompromised individual with history of valve disease. This outcome supports the need for further validation through clinical trials.
KEY FINDINGS: PDT mediated by MB is an effective and affordable approach for treating FEH associated with HPV in immunosuppressed patients, offering favorable outcomes and improved quality of life.
BACKGROUND: Human papillomavirus (HPV) infections are a major cause of oral lesions, and in individuals living with HIV, lesions such as focal epithelial hyperplasia (FEH) may persist or exhibit atypical features, potentially progressing to more severe conditions if untreated. Managing oral HPV lesions in immunocompromised patients is challenging, as conventional therapies may carry higher risks or show limited efficacy.
DETAILS: This study reports the case of a 49-year-old HIV-positive male with valve disease and arthritis, requiring crutches for mobility. He presented with multiple painless oral lesions, diagnosed as FEH associated with oral HPV, and had previously undergone unsuccessful treatments. Photodynamic therapy (PDT) using methylene blue (MB) and a red laser was proposed as a treatment. Topical MB-mediated PDT successfully cleared the FEH lesions, with no recurrence observed over 24 months.
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Source: de Araújo, J. C., Paiva, H. C., Faara, P. M. M., et al. Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy. A Case Report. Lasers in Surgery and Medicine. 2026; 58(2): 70-73. Published: February, 2026. DOI: 10.1002/lsm.70091
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