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Objective: Breaking Bad News (BBN) is challenging in pediatric oncology. It requires tailored, sensitive communication to families and children at critical moments. However, pediatric oncology lacks context-specific BBN support tools. The OKRA project aims to address this gap by developing and refining a support tool with a participatory approach., Methods: The OKRA-Compass was developed using a participatory action research (PAR) approach with mixed methods. It involved iterative refinement across five pediatric oncology clinics. Improvements were based on feedback from focus groups, surveys, and written suggestions. The interdisciplinary research team collaborated with healthcare professionals (HCPs) as coresearchers to ensure practical applicability, acceptance, and user-centered design., Results: The OKRA-Compass provides a structured but flexible framework for BBN in pediatric oncology, comprising a comprehensive guidebook, pocket guide, and checklists. Its application improved team preparation, communication style, and role clarity during emotionally demanding encounters., Conclusion: The structured framework of the OKRA-Compass aligns theoretical foundations with clinical practice. Its participatory development process fostered collaboration and ownership among HCPs, making it a valuable resource for improving communication in pediatric oncology., Practice Implications: Integrating the OKRA-Compass into training programs and clinical routines may promote empathic, patient-centered care. We recommend interprofessional training to further support its application and dissemination., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier B.V.)

Background: The contribution of tumor type, multimodal treatment, and other patient-related factors upon long-term cognitive sequelae in infant brain tumor survivors remains undefined. We add our retrospective analysis of neuropsychological and quality of survival (QoS) outcome data of survivors of atypical teratoid/rhabdoid tumors (ATRT) and extracranial malignant rhabdoid tumors of the soft tissues (eMRT) and kidneys (RTK) treated within the same framework. Neuropsychological data from children with ATRT were compared to data from children with non-irradiated low-grade glioma (LGG)., Patients and Methods: Following surgery, patients (0-36 months at diagnosis) had received radio-chemotherapy (up to 54 Gy; ATRT: n = 13; eMRT/RTK: n = 7), chemotherapy only (LGG: n = 4; eMRT/RTK: n = 1) or had been observed (LGG: n = 11). Neuropsychological evaluation employing comparable tests was performed at median 6.8 years (ATRT), 6.6 years (eMRT/RTK), and 5.2 years (LGG) post diagnosis., Results: We detected sequelae in various domains for all tumor types. Group comparison showed impairments, specifically in fluid intelligence (p = .041; d = 1.11) and visual processing (p = .001; d = 2.09) in ATRT patients when compared to LGG patients. Results for psychomotor speed and attention abilities were significantly below the norm for both groups (p < .001-.019; d = 0.79-1.90). Diagnosis predicted impairments of cognitive outcome, while sex- and age-related variables did not. QoS outcome for all rhabdoid patients displayed impairments mainly in social (p = .008; d = 0.74) and school functioning (p = .048; d = 0.67), as well as lower overall scores in psychosocial functioning (p = .023; d = 0.78) and quality of life (p = .006; d = 0.79) compared to healthy controls., Conclusion: Survivors of infant ATRT experience various late effects in cognition and QoS following multimodal treatment, while infant LGG patients without radiotherapy demonstrated comparable impairments in psychomotor and attention abilities. Early onset and multimodal treatment of rhabdoid tumors require close monitoring of neuropsychological and QoS sequelae., (© 2024 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

In this multicenter survey (July 07 to August 08, 2020) in pediatric oncology centers (POCs) belonging to the German Society for Pediatric Oncology and Hematology (GPOH), 36 POCs participated (response rate 70.6%). Home schooling practice was judged as satisfying by 79% prior to and by 38% during the pandemic ( P =0.0007). The individual risk of a SARS-CoV-2 infection and the risk of transmission to other patients/caregivers were arguments against attendance. Most POCs recommended regular social participation/school attendance after the end of intensive therapy. 81% stated that persisting restrictions result in serious negative psychosocial consequences for the patients and their families. In-hospital school education, home schooling and re-attendance of school and kindergarten among pediatric cancer patients have suffered a severe setback during the SARS-CoV-2 pandemic. Continuous communication and education concerning protective measures as well as an individual risk assessment are required to avoid the detrimental exclusion of pediatric oncology patients from kindergarten and school., Competing Interests: The German Society for Pediatric Infectious Diseases (DGPI) supported the realization of this survey. AS is second chairperson of the DGPI. MS is the chairman of the German Society for Pediatric Oncology and Hematology (GPOH). TL is the coordinator, and AS, AHG and HJL are members of the Working group on Infections in Pediatric Cancer Patients of the GPOH. AHG: no COIs in the context of this work. MS: no COIs in the context of this work., (Copyright © 2021 Simon et al.)

Background: There is a long history of research suggesting that Chlamydophila pneumoniae is associated with coronary artery disease (CAD). C. pneumoniae in peripheral blood mononuclear cells (PBMCs) could serve as a risk factor for CAD if respiratory infection with C. pneumoniae spreads to atherosclerotic plaques through PBMCs or if infected plaques shed C. pneumoniae-laden PBMCs into the circulation., Methods: PBMCs were collected from 86 case patients with abnormal coronary angiogram findings and from 91 age- and gender-matched healthy control subjects. The healthy control subjects were strictly defined as not having atherosclerosis on the basis of absence of both clinical atherosclerotic disease and traditional risk factors for CAD. PBMCs were probed for the presence of C. pneumoniae nucleic acid by 2 separate real-time polymerase chain reaction (PCR) assays that used primers for outer membrane protein A (ompA) and 16S ribosomal RNA. C. pneumoniae serologic findings were determined for both case patients and control subjects., Results: Despite serologic findings indicating past exposure to C. pneumoniae (immunoglobulin G titer, >or=1:16) in 74% of case patients with CAD and control subjects, no C. pneumoniae DNA or RNA was detected in PBMCs from any of the case patients or control subjects, including a subset of 42 participants (18 with CAD) who had samples obtained serially over 8 months. Multiple laboratory controls, including controls for inhibition of PCR, produced expected results., Conclusions: The uniformly negative results with use of highly sensitive methods are in contrast to much of the published literature. Probing of PBMCs for the genes of C. pneumoniae does not appear useful as a noninvasive way of detecting the presence of C. pneumoniae in atheromatous lesions.

We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal (NM) therapy for preventing urinary tract infection (UTI) in postmenopausal women with recurrent UTI. Over a period of 9 months, 86 women received an estriol-containing vaginal pessary (0.5 mg estriol) twice weekly, and 85 women received NM (100 mg) once daily. We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM (P=.0003). Twenty-eight women (32.6%) who received estriol had no episodes of UTI versus 41 women (48.2%) in the NM group. There was a significant increase in the number of superficial cells in women who received estriol, whereas in the NM group, no such changes occurred. However, there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol. Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women.

This study evaluated whether trimethoprim-sulfamethoxazole (TMP-SMX) is effective for treatment of uncomplicated urinary tract infections (UTIs) due to TMP-SMX-resistant (TMP-SMX-R) pathogens. Healthy nonpregnant premenopausal women with symptomatic lower UTI were assessed for the presence of pyuria and bacteriuria; if either was present, a urine sample was cultured and TMP-SMX was prescribed. Clinical and microbiologic cure was assessed at days 5-9 and 28-42 after cessation of therapy. For 71%, of patients, cultures grew TMP-SMX-susceptible (TMP-SMX-S) microorganisms, and for 29%, cultures grew TMP-SMX-R organisms. Escherichia coli remained the predominant bacteria in both groups of cultures. At visit 2, microbiological cure had been achieved in 86% of the patients in the TMP-SMX-S group and 42% of those in the TMP-SMX-R group. Similar differences were found at visit 3 by clinical evaluation. Treatment with TMP-SMX of uncomplicated UTI caused by TMP-SMX-R microorganisms results in microbiologic and clinical failure. In high-resistance areas, TMP-SMX should not be the empiric drug of choice for uncomplicated UTI.

To determine the effect of human immunodeficiency virus type 1 (HIV-1) infection upon pelvic inflammatory disease (PID), a laparoscopic study of acute PID was conducted in Nairobi, Kenya. Subjects underwent diagnostic laparoscopy, HIV-1 serology, and testing for sexually transmitted diseases. Of the 133 women with laparoscopically verified salpingitis, 52 (39%) were HIV-1-seropositive. Tubo-ovarian abscesses (TOA) were found in 33% of HIV-1-infected and 15% of HIV-1-uninfected women (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.2-6.5). Among seropositive women, TOA was found in 55% of those with CD4 cell percent <14% vs. 28% with CD4 cell percent>14% (OR 3.1, 95% CI 0.6-15.3). Neisseria gonorrhoeae was detected in 37 women (28%) and Chlamydia trachomatis in 12 (9%); neither was significantly related to HIV-1 seropositivity. Length of hospitalization was not affected by HIV-1 serostatus overall but was prolonged among HIV-1-infected women with CD4 cell percent <14%. Among patients with acute salpingitis, likelihood of TOA was related to HIV-1 infection and advanced immunosuppression. In general, HIV-1-seropositive women with acute salpingitis responded well to treatment.

Background and Objectives: The sexually transmitted diseases (STD) control program for female sex workers (FSW) in Lima, Peru, provided periodic serological tests for syphilis and cervical smears for gonococci, but not medication for STD or condoms., Goal of This Study: To assess program effectiveness., Study Design: We assessed prevalence of current STD and serum antibody to STD pathogens in FSW in relation to program participation and to condom use., Results: Program participation was not associated with significantly reduced rates of current gonococcal or chlamydial infections or Venereal Disease Research Laboratory (VDRL) titers > or =4 with reactive fluorescent treponemal antibody absorption (FTA-ABS). However, regardless of control program participation, consistent condom use was associated with reduced prevalence of gonorrhea, and with significantly reduced seroreactivity for FTA-ABS, C. trachomatis, anti-hepatitis B core (HBc), and anti-human T-lymphotropic virus type I. Anti-HBc was associated with years of receiving penicillin injections for syphilis prophylaxis., Conclusion: The scope, quality, and efficacy of STD control programs must be technically appropriate, well managed, and adequately financed. The safety of marginal programs warrants scrutiny.

This multicenter, prospective, double-blind study compared the safety and efficacy of clindamycin and ciprofloxacin versus ceftriaxone and doxycycline in the treatment of outpatients with mild to moderate pelvic inflammatory disease (PID) diagnosed by laparoscopy. Samples taken from the endocervix, endometrium, and abdominal cavity before treatment and from the endocervix after treatment were cultured for aerobes, anaerobes, Neisseria gonorrhoeae, and Chlamydia trachomatis. Of the 138 patients enrolled, 131 were evaluable for efficacy. The most prevalent bacteria were streptococci, staphylococci, and Escherichia coli (among aerobes) and Bacteroides species and peptostreptococci (among anaerobes). N. gonorrhoeae was present in 2% (3) of the 131 evaluable patients, and C. trachomatis was in 11% (15). The clinical cure rate was 97% (65 of 67) in the clindamycin and ciprofloxacin group and 95% (61 of 64) in the ceftriaxone and doxycycline group. Side effects were similar in both groups. In conclusion, the two regimens for the outpatient treatment of mild to moderate PID were similarly effective and safe.

Four hundred female sex workers attending a sexually transmitted disease clinic in Lima, Peru, were interviewed for demographic information and medical, contraceptive, and sexual practice histories. Cervical cultures were done for Neisseria gonorrhoeae and Chlamydia trachomatis, and serum was tested for antibodies to human immunodeficiency virus, human T cell lymphotropic virus type I (HTLV-I), Treponema pallidum, C. trachomatis, herpes simplex virus type 2 (HSV-2), and Haemophilus ducreyi. The prevalence of HTLV-I increased with duration of prostitution from 3.6% (< 3 years) to 9.3% (3-6 years) to 15.9% (> 6 years; P < .01). After adjustment for duration of prostitution, reduced risk of HTLV-I was significantly correlated with condom use for more than half of all sexual exposures for > 3 years (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.13-0.89). Further adjusting for condom use, HTLV-I seropositivity was associated with C. trachomatis (OR, 3.7; 95% CI, 1.4-13.2) and with antibody to HSV-2 (OR, 3.7; 95% CI, 0.5-29.6). Thus, duration of prostitution, lack of consistent condom use, and past infection with C. trachomatis were significantly associated with HTLV-I seropositivity.

A newly developed microwell enzyme immunosorbent assay (EIA) system by Syva Company (Palo Alto, CA) can detect Chlamydia trachomatis in < 3 hr. It uses a polyclonal antibody to chlamydial lipopolysaccharide and end points are determined with a spectrophotometer. Three clinical trial sites (University of California Medical Center, San Francisco, CA; University of Washington, Seattle, WA; and Louisiana State University Medical Center, New Orleans, LA), compared this EIA with tissue culture (TC) for identifying Chlamydia in urogenital specimens. Overall prevalence by TC was 10.4% (136 of 1306). When tests were compared with TC (using vials or microtiter plates and a fluorescent antibody stain), we found an EIA sensitivity of 93.4% (127 of 136) and a specificity of 98.1% (1148 of 1170). This EIA has a performance profile that is, at the very least, comparable with other nonculture methods for diagnosing genital tract infections with C. trachomatis.

Since MS-fimbriated bacteria adhere to Tamm-Horsfall protein, it has been suggested that Tamm-Horsfall protein may trap urinary pathogens and prevent them from colonizing the mucosal surfaces of the urinary tract. To test the hypothesis that low urinary Tamm-Horsfall protein excretion rates predispose to urinary tract infection we obtained serial urine samples from 17 women with and 18 without a history of recurrent urinary tract infection. None of the women had known structural abnormalities of the urinary tract. Concentrations of Tamm-Horsfall protein in urine were measured with a sensitive enzyme-linked immunosorbent assay method. On the average, 3 urine samples per person collected within 3 to 6 months were analyzed. The mean Tamm-Horsfall protein excretion of women with recurrent urinary tract infection was 57.0 mg./l. and that of controls was 66.3 mg./l.; this difference was not statistically significant. The mean coefficient of variation was 44.2 and 62.1%, respectively. We conclude that urinary Tamm-Horsfall protein concentration is not significantly decreased in women with recurrent urinary tract infection compared with controls, and that excretion varies widely in repeat samples obtained from the same individual.

Enzyme immunoassays for the detection of chlamydial antigens are commonly used to diagnose Chlamydia trachomatis infection. As is true for all nonculture methods, the specificities of these tests are a concern. A confirmatory blocking assay (Abbott Laboratories, North Chicago, Ill.) was evaluated at four sexually transmitted disease test sites. This assay is designed to confirm true-positive Chlamydiazyme (CZ) specimens and to identify false-positive CZ reactions caused by cross-reacting bacteria. Cervical specimens were collected from 2,891 women. Chlamydia prevalence by tissue culture (TC) was 9.2% (266 of 2,891 specimens). Compared with TC, the sensitivity and specificity of CZ were 78.9% (210 of 266 specimens) and 98.2% (2,577 of 2,625 specimens), respectively. There were 48 CZ false-positive reactions. The direct fluorescent-antibody test (DFA) was positive for 31 of 48 false-positive reactions, indicating culture misses. Thus, when the standard was both TC and DFA, CZ sensitivity was 81.1% and CZ specificity was 99.3%. Of the 17 CZ-positive patients who were negative by both TC and DFA, 3 were negative on repeat CZ and 11 of 14 were identified as false positive by the confirmatory assay. The confirmatory test was positive for CZ-positive women who were positive by TC or DFA. Use of the confirmatory test, which increased the specificity to 99.9%, would increase confidence in positive CZ results and make the test more useful for screening populations with a low prevalence of C. trachomatis infection.

The utility of whole-genomic DNA probes for the detection of infections by genital mycoplasmas was investigated in 220 men attending a sexually transmitted diseases clinic. In 144 patients, probe results were compared with quantitative culture results. The prevalence of Mycoplasma hominis was 11% by culture, whereas the prevalence of ureaplasmas was 38%. The M. hominis DNA probe detected 9 of 16 M. hominis culture-positive specimens and 2 of 128 culture-negative specimens. The Ureaplasma urealyticum DNA probe detected 36 of 57 U. urealyticum culture-positive specimens and 18 of 87 culture-negative specimens. Most of the probe-negative culture-positive specimens had colony counts of less than 10(3) organisms/ml of specimen. The DNA probe does not require viable organisms, and the probe-positive, culture-negative specimens suggest that false-negative cultures occurred, perhaps due to specimen handling or insensitivity of culture methods for some strains of mycoplasmas.

The analysis of expired breath with a portable electrochemical cell after carbon monoxide exposure provides a practical field method for the rapid estimation of carboxyhemoglobin. A fire fighter can collect and analyze his own breath sample for CO, an operation that requires 1 1/2 minutes. This simple technique has the accuracy necessary to determine compliance with the regulations governing occupational exposure to CO.

The preparation and nature of the International Reference Preparation of Tetracosactide for Bioassay (IRP; in ampoules coded 80/590) are described. The IRP was studied by six laboratories in five countries using in-vivo and in-vitro bioassays and various physicochemical methods. The bulk (1-24)corticotrophin-tetracosapeptide (batch 000179) from which the IRP was prepared contained 10.4% (w/w) acetic acid and 8.3% (w/w) water; its (1-24)corticotrophin-tetracosapeptide content was estimated to be 71.7% (w/w) by amino acid analysis, 74.2% (w/w) by high performance liquid chromatography (HPLC) and 77.5% (w/w) by spectrophotometry. (1-24)Corticotrophin-tetracosapeptide accounted for more than 90% (w/w) of the total peptide in the IRP as judged by HPLC, thin-layer chromatography, carboxymethyl-cellulose chromatography, isoelectric focusing (IEF) and electrophoresis. The homogeneity of the peptide in the IRP was similar by all methods to that in batch 000179 from which it was prepared. The (1-24)corticotrophin-tetracosapeptide content of the IRP (with 95% confidence limits), in terms of batch 000179, was found to be 491 micrograms/ampoule by HPLC and spectrophotometry, 473 (433-513) micrograms/ampoule by IEF and 505 (473-539) micrograms/ampoule by the in-vitro rat adrenocortical cell assay. A comparison in the same bioassay system of the IRP with a laboratory house standard of (1-24)corticotrophin-tetracosapeptide, which originated from a different manufacturer, gave similar results. Accelerated thermal degradation studies of the IRP by adrenocortical cell assay, HPLC and IEF suggested that more than 99.9% of its original content of (1-24)corticotrophin-tetracosapeptide would remain after 10 years under normal storage conditions of -20 degrees C in the dark. Bioassay estimates of samples of the IRP which had undergone significant degradation were higher than estimates by HPLC, indicating that molecular species other than (1-24)corticotrophin-tetracosapeptide contributed to their corticotrophic activity. The corticotrophic activity of the IRP was demonstrated by cytochemical bioassay and by in-vivo bioassays as well as by the adrenocortical cell assay. After consideration of these data, the Expert Committee on Biological Standardization of the World Health Organization established the ampoule d preparation, coded 80/590, as the International Reference Preparation of Tetracosactide for Bioassay and assigned to it a potency of 490 i.u./ampoule; thus the i.u. is represented by 1 microgram (1-24)corticotrophin-tetracosapeptide.

Urinary tract infections appear to be responsible for 35 percent of all hospital-acquired infections, occurring in approximately two patients per 100 admissions. The great majority of infections are associated with urinary tract instrumentation. Female sex, advanced age and debilitating underlying illness appear to be associated with an increased risk of infection, but other risk factors have been poorly defined and case-control studies assessing excess morbidity and mortality associated with nosocomial bacteriuria have not been made. In most instances, the hospitalized patients are the reservoirs for the etiologic organisms, but cross-infection from other infected patients also occurs. Current preventive efforts have been primarily directed at aseptic catheter care techniques and reducing catheter use. Further developments in our prevention and control of these infections require an understanding of the mechanisms responsible for colonization of the urethra and bladder with gram-negative organisms and ways to discriminate patients at special risk.