Pediatric KT in children up to 15 kg: A single-center experience.

BACKGROUND: KT is the preferred treatment for ESRD in pediatrics. However, it may be challenging in those weighing ≤15 kg with potential complications that impact on morbidity and graft loss. METHODS: This retrospective review reports our experience in KT in children, weighing ≤15 kg, and the strategies to reduce morbidity and mortality. RESULTS: All patients were on RRT prior to KT. Patients reached ESRD mainly due to urologic malformations (54.54%). LD was performed in 82% of patients. The recipient's median age was 2.83 years, and median weight 12.280 kg. Male sex was predominant (73%). All patients required transfusions of PRBCs. There was a high requirement for ventilated support in patients post-KT with no relation to weight, amount of resuscitation used intra-operatively or ml/kg of PRBCs. One patient presented with stenosis of the native renal artery. No patients presented DGF, graft thrombosis, or surgical complications. No association was found between cold ischemia and eGFR at 1 year (p = .12). In univariate analysis, eGFR at 1 year is related to AR. eGFR at 3 years is related to the number of UTI. Median follow-up was 1363 days. Patient and graft survival were 100%. CONCLUSIONS: KT in children ≤15 kg can be challenging and requires a meticulous perioperative management and surgical expertise. Patient and graft survival are excellent with low rate of complications.

Kidney transplant to vesicostomy: A safe strategy for children with end stage renal disease and lower urinary tract anomalies.

INTRODUCTION: Resolution of underlying urinary tract anomalies prior to kidney transplantation in patients with end stage renal disease (ESRD) secondary to uropathy, has been historically supported under the argument that this would help prevent infectious complications and graft loss. We propose to perform earlier kidney transplantation with a transient vesicostomy, deferring resolution of the uropathy to the post-transplantation period. The aim of this study was to evaluate the outcomes of kidney transplantation in children with a vesicostomy. MATERIAL AND METHODS: A retrospective, multicenter study was performed including all patients under 18 years of age who underwent kidney transplantation with a vesicostomy, between January 2005 and December 2020 and had at least one year of follow up. Data related with the indication and timing of vesicostomy, time until transplantation, post-transplantation complications, urinary tract infections (UTI) and graft survival rate were collected. RESULTS: Of the 758 transplantations performed in the study period, 16 patients met the inclusion criteria. Mean age at transplantation was 58 months (range 20-151), and mean weight was 13.5 Kg (range 8.4-20). Mean time from vesicostomy to kidney transplantation was 30 months (range 0-70). There were 2 (12.5%) ureteral complications that required reoperation. Eighteen episodes of UTI were identified in 8 patients (50%), accounting for 0.4 UTIs per patient-year of follow-up. UTIs did not lead to graft loss in any of the cases. Urinary tract reconstruction was performed in 5 patients (31.3%) at an interval of 1-91 months post-transplantation. After a mean follow-up of 44.8 months (range 13-200) from transplantation, patients with vesicostomy had a mean creatinine clearance of 86.6 ml/min/1.73 m2, with a mean serum creatinine level of 0.6 mg/dl. Graft survival rate was 100%. DISCUSSION: Early kidney transplantation into a vesicostomy permits a resolution of the ESRD, avoiding deleterious effects related to dialysis. With a low rate of UTIs, we found no graft loss due to infectious complications. This strategy permits careful planning and better timing for the urinary tract reconstruction without delaying kidney transplantation. CONCLUSION: Kidney transplantation in pediatric patients with vesicostomy seems to be a safe and effective strategy. UTI rate was similar to that reported in the literature of patients with corrected urinary anomalies undergoing kidney transplantation without urinary diversion.

Congenital Bladder Prolapse Through a Patent Urachus: Two Institutions' Experience.

We describe our experience in 2 institutions handling bladder prolapse through a patent urachus (PU), together with a brief review of published literature. Case 1: A term neonate with congenital prolapsed bladder via PU. Ultrasound at 21 weeks gestation revealed a male fetus with a large midline pelvic cyst communicating with the bladder which disappeared on subsequent 27 weeks ultrasound. Case 2: A term female neonate with congenital prolapsed bladder via PU with no prenatal diagnosis. In both cases the bladder closure was undertaken during the newborns' first days of life.

Salud integral del joven y del adolescente. Medicina preventiva y social / Comprehensive health of young people and adolescents. Preventive and social medicine

La salud integral del adolescente y del joven tiene un enfoque bio-psico-social, y es una tarea conjunta de los equipos de salud y de la sociedad. Esta tarea mixta no solo tiene una enorme repercusión inmediata sobre este grupo etario, sino que repercute también a posteriori en el crecimiento y desarrollo durante las edades más productivas de la vida. Por ello, debe ponerse especial énfasis en las actividades de promoción, prevención y protección de la salud del adolescente, que comprometan políticas de Estado. (AU)

The comprehensive health of young people and adolescents has a bio psycho social approach and is a joint task of society and the health team. This mixed task not only has an enormous immediate impact on this age group but also a notable projection towards the growing and development during the most productive ages of life. For this reason, special emphasis should be placed on promotion, prevention and protection of the adolescent health that compromise State Policies. (AU)

El médico generalista en la consulta casual con el paciente adolescente / The general practitioner and the casual consultation with the adolescent patient

Se destaca la importancia de la primera consulta médica del paciente joven, que llega a la guardia médica y es recibido por un médico generalista. Es el momento ideal para realizar una medicina basada en la prevención de enfermedades orgánicas, socioculturales y psicopedagógicas que puedan comprometer la salud del adolescente. Se señalan algunos datos que el médico generalista puede obtener en esta primera entrevista sobre anomalías en el desarrollo puberal y factores de riesgo socioculturales y psicopedagógicos que pueden poner en riesgo la salud y la vida del adolescente que consulta, para realizar la posterior derivación al especialista en adolescentes.

The importance of the first medical consultation of the young patient is highlighted. It's the ideal moment to carry out a medicine based on the prevention of organic, sociocultural and psychopedagogical diseases that may compromise adolescent health. Some data that the general practitioner can obtain in this first interview about anomalies in pubertal development, sociocultural and psychopedagogical risk factors that may put at risk the health and life of the adolescent who consults and make your subsequent referral to the Teen Specialist, are point out.

Formation of corporal tissue architecture in vivo using human cavernosal muscle and endothelial cells seeded on collagen matrices.

We explored the feasibility of developing corporal tissue, consisting of human cavernosal smooth muscle and endothelial cells in vivo, using three-dimensional acellular collagen matrices, which are similar in architecture to native corpora. Acellular collagen matrices were derived from processed donor rabbit corpora, using cell lysis techniques. Human corpus cavernosal muscle and endothelial cells were seeded on the acellular matrices. A total of 80 matrices, 20 without cells and 60 with cells, were implanted subcutaneously in athymic mice. An additional 36 matrices seeded with cells were maintained in culture for up to 4 weeks. Hydroxyproline quantification, Western blot analysis, RT-PCR, and scanning electron microscopy of the matrices, with and without cells, were performed at various time points. Animals were killed 3 days and 1, 2, 3, 4, 6, and 8 weeks after implantation. Immunocytochemical and histological analyses were performed to confirm the muscle and endothelial phenotype. Organ bath studies were performed in order to determine the degree of tissue contraction. Western blot analysis detected alpha-actin, myosin, and tropomyosin proteins from human corporal smooth muscle cells. Expression of muscarinic acetylcholine receptor (mAChR) subtype m4 mRNA was demonstrated by RT-PCR from corporal muscle cells before and 8 weeks after seeding. The implanted matrices showed neovascularity into the sinusoidal spaces by 1 week after implantation. Increasing organization of smooth muscle and endothelial cells lining the sinusoidal walls was observed at 2 weeks and continued with time. The matrices were covered with the appropriate cell architecture 4 weeks after implantation. The matrices showed a stable collagen concentration over 8 weeks, as determined by hydroxyproline quantification. Immunocytochemical studies using alpha-actin and factor VIII antibodies confirmed the presence of corporal smooth muscle and endothelial cells, both in vitro and in vivo, at all time points. There was no evidence of cellular organization in the control matrices. Organ bath studies showed that the cell-seeded corporal tissue matrices responded to electrical field stimulation, whereas the unseeded implants failed to respond. This study demonstrates that human cavernosal smooth muscle and endothelial cells seeded on three-dimensional acellular collagen matrices derived from donor corpora are able to form well-vascularized corporal tissues in vivo.

Enseñanza de la pediatría: aprendizaje, capacitación en pregrado e internado anual rotatorio. Experiencia docente durante 35 años / Teaching of pediatrics: learning, training and internship undergraduate annual rotation. 35 years experience in teaching

El objetivo de este trabajo es presentar mi tarea docente asistencial desarrollada durante 35 años en la Unidad Académica de un Hospital General. Considero que el equipo docente tiene el compromiso de formar a los futuros médicos para que ellos estén en condiciones de: contemplar el aspecto humanístico de la Medicina con enfoque ecológico del niño, la familia y la sociedad; promover la formación y utilización de criterios médicos en base a resolución de casos clínicos; obtener actitudes y logros en su formación y su capacitación; detectar necesidades y recursos en el área materno-infantil que les permita atender niños y adolescentes de distintas áreas geográficas, socioculturales y económicas; y poder desempeñarse como agente de promoción y cuidado de la salud, protegiendo a la familia y la comunidad.

The objective of this paper is presenting my work as a teacher and as a doctor during thirty-five years in an Academic Unit of a General Hospital. Considering that the teams of teachers that I work with have also the compromise of preparing futures doctors, so that there are in conditions of: Consider the human aspect of the medicine, the patient and his family’s environment; Promoting in the students the formation based in the study of practical medicine cases; Being able to become in excellent professionals by accomplishing different achievements during their career; Finding out needs and resources in the maternal and infant area, which allows them serving kids and teenagers of different cultures and social situations; Being capable to perform as a social agent of promotion of the health care, as a way of protection of the family and the community.

Experiencia educativa para estudiantes de medicina de la Universidad de Buenos Aires (UBA) en la evaluación del Calendario Nacional de Vacunación de niños que concurrieron a Hospitales de la Ciudad Autónoma de Buenos Aires (CABA) / Educational experience for medical students at the University of Buenos Aires (UBA) in the evaluation of the National Vaccination Calendar of children who attended hospitals of the Autonomous City of Buenos Aires (CABA)

Objetivos: La participación de alumnos en estudios que evalúan el cumplimiento del programa de Inmunizaciones (PAI) y sus causales representa una experiencia relevante. La evaluación del cumplimiento del PAI permite proponer estrategias para aumentar coberturas.Métodos: Estudio observacional, analítico, transversal. Población: Neonatos a 11 años de edad, realizado en 6 hospitales de la CABA. Período: 1/06-31/12/2014. Participaron estudiantes del internado anual rotatorio capacitados sobre PAI,supervisados por docentes.Criterio de inclusión: Presentar el carné de vacunación, no tener condiciones que impidieran indicación del PAI.Resultados: Encuestas 531. Esquema incompleto o no recibió ninguna vacuna 25,7 por ciento. Se asociaron a incumplimiento las siguientes variables: Edad <1 año, edad materna <28 años, escasa educación materna, embarazo no controlado, ausencia de control de salud, internados, consulta porenfermedad. Análisis multivariado: falta de control de salud: RR 2,1(IC 95 por ciento:1,4-2,9).Como motivo de OPV predominó olvido (71,8 por ciento). Los alumnos refirieron útil su participación. Consideraron positivo aprender a investigar, contacto con pacientes y familiares, trabajar en equipo. Negativo: restó tiempo para estudiar.Conclusiones: Interactuar con la comunidad permitiría eliminar barreras que condicionan OPV. La comunicación es valiosa para lograr este objetivo. La participación supervisada de alumnos fue una experiencia innovadora, al introducirlos en la investigación clínica.

Introduction: The participation of students in research studies is a valuable teaching objective. Particularly evaluating implementation of the National immunization Program and their causal, allowing to propose strategies to increase coverage.Methods: An observational, analytical, crosssectional study. Population: Newborn to 11 years old, conducted in 6 hospitals of Buenos Aires city. Period: 1/06-31/12/2014. Pediatrics students belonging to the pediatric annualtraining in pediatrics, supervised by their teachers. Inclusion criteria: Presentation the vaccination card, have no conditions that would prevent indication of the vaccines.Results: 531 surveys were completed.Incomplete scheme, or no received vaccine 25.7 percent. The following variables were associated with non-compliance schedule: Age <1 year, maternal age <28 years, lowmaternal education, uncontrolled pregnancy, lack of health control, boarding, ambulatory consult for disease. Multivariate analysis: lackof control health: RR 2.1 (95 percent CI: 1.4-2.9).Family forgot vaccinate the child prevailed (71.8 percent). Students reported their participation useful. They considered positive learning how to research, contact with patients andfamilies, teamwork. As negative: Rest time to study.Conclusions: Interacting with the community enable barriers that condition not comply with the scheme. Communication is valuable to achieving this aim. Supervised student participation was an innovative experience to introduce in clinical research.