Acute Kidney Injury and Renal Tubular Damage in Children With Type 1 Diabetes Mellitus Onset.

CONTEXT: Acute kidney injury (AKI) and renal tubular damage (RTD), especially if complicated by acute tubular necrosis (ATN), could increase the risk of later chronic kidney disease. No prospective studies on AKI and RTD in children with type1diabetes mellitus (T1DM) onset are available. OBJECTIVES: To evaluate the AKI and RTD prevalence and their rate and timing of recovery in children with T1DM onset. DESIGN: Prospective study. SETTINGS AND PATIENTS: 185 children were followed up after 14 days from T1DM onset. The patients who did not recover from AKI/RTD were followed-up 30 and 60 days later. MAIN OUTCOME MEASURES: AKI was defined according to the KDIGO criteria. RTD was defined by abnormal urinary beta-2-microglobulin and/or neutrophil gelatinase-associated lipocalin and/or tubular reabsorption of phosphate < 85% and/or fractional excretion of Na (FENa) > 2%. ATN was defined by RTD+AKI, prerenal (P)-AKI by AKI+FENa < 1%, and acute tubular damage (ATD) by RTD without AKI. RESULTS: Prevalence of diabetic ketoacidosis (DKA) and AKI were 51.4% and 43.8%, respectively. Prevalence of AKI in T1DM patients with and without DKA was 65.2% and 21.1%, respectively; 33.3% reached AKI stage 2, and 66.7% of patients reached AKI stage 1. RTD was evident in 136/185 (73.5%) patients (32.4% showed ATN; 11.4%, P-AKI; 29.7%, ATD). All patients with DKA or AKI presented with RTD. The physiological and biochemical parameters of AKI and RTD were normal again in all patients. The former within 14 days and the latter within 2months. CONCLUSIONS: Most patients with T1DM onset may develop AKI and/or RTD, especially if presenting with DKA. Over time the physiological and biochemical parameters of AKI/RTD normalize in all patients.

Nonpegylated liposomal doxorubicin combination regimen in patients with diffuse large B-cell lymphoma and cardiac comorbidity. Results of the HEART01 phase II trial conducted by the Fondazione Italiana Linfomi.

The purpose of this phase 2, multicenter study was to determine the activity and safety of nonpegylated liposomal doxorubicin as part of "R-COMP" combination in patients with diffuse large B-cell lymphoma and coexisting cardiac disorders. The study was conducted using a Bayesian continuing assessment method using complete remission rate and rate of cardiac events as study endpoints. Between November 2009 and October 2011, 50 evaluable patients were enrolled (median age, 76 years). Median baseline left ventricular ejection fraction (LVEF) was 60%. Ischemic cardiopathy was the most frequent preexisting cardiac disorder (35%), followed by atrial fibrillation (15%), left ventricular hypertrophy (13%), and baseline LVEF <50% (12%). Based on the intent to treat analysis, overall response rate was 72%, including 28 patients in complete remission (complete remission rate, 56%), and 8 in partial remission (16%). At the end of treatment, grades 3 to 4 cardiac events were observed in 6 patients. No significant modifications from baseline values of LVEF were observed during treatment and follow-up. Nonpegylated liposomal doxorubicin instead of doxorubicin in the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen is a feasible option for patients with diffuse large B-cell lymphoma presenting with concomitant cardiac disorders.

Endoscopia digestiva en la etapa neonatal: Revisión de la literatura / Digestive endoscopy in the neonatal period: Literature review

Objetivo: Evaluar la eficacia de la endoscopia digestiva diagnóstica y terapéutica en el periodo neonatal. Material y métodos: Se realizó una revisión electrónica en bases de datos MEDLINE y PubMed entre los años 1984-2009 con las siguientes palabras bronchoscopy, endoscopy neonatal. Se incluyeron artículos de revisión bibliográfica y descripción de series de casos. Para el análisis de la información se describen los diferentes artículos. Resultados: Se obtuvieron 850 artículos de endoscopia pediátrica, de los cuales sólo 20 fueron elegidos y revisados para el reporte de resultados de los recién nacidos. Las variables estudiadas fueron indicación, contraindicaciónes, hallazgos y manejo terapéutico. Conclusión: La endoscopia es una herramienta segura y efectiva para el diagnóstico y tratamiento de las diversas entidades patológicas del recién nacido, siempre y cuando se realice por un equipo multidisciplinario.

Objective: To assess the effectiveness of diagnostic and therapeutic bronchoscopy in pediatric age, with emphasis on neonatal period. Material and methods: We performed an electronic review of internet databases MEDLINE and PUBMED, from 1984-2009. The search used the following keywords bronchoscopy, endoscopy and neonatal. The types of study included were: literature review and description of series of cases. For the information analysis, the different articles were described. Results: Of the 850 articles found, only 20 were selected and reviewed. The variables studied were indication, contraindication, findings and therapeutic management. Conclusion: Bronchoscopy is a safe and effective tool for diagnosis and treatment of several pathologies of the new born, when it was carried out by a multidisciplinary team.