100 YEARS OF VITAMIN D: Supraphysiological doses of vitamin D changes brainwave activity patterns in rats.

Low plasma levels of vitamin D causes bone mineral change that can precipitate osteopenia and osteoporosis and could aggravate autoimmune diseases, hypertension and diabetes. The demand for vitamin D supplementation becomes necessary; however, the consumption of vitamin D is not without risks, which its toxicity could have potentially serious consequences related to hypervitaminosis D, such as hypercalcemia and cerebral alterations. Thus, the present study describes the electroencephalographic changes caused by supraphysiological doses of vitamin D in the brain electrical dynamics and the electrocardiographic changes. After 4 days of treatment with vitamin D at a dose of 25,000 IU/kg, the serum calcium levels found were increased in comparison with the control group. The electrocorticogram analysis found a reduction in wave activity in the delta, theta, alpha and beta frequency bands. For ECG was observed changes with shortened QT follow-up, which could be related to serum calcium concentration. This study presented important evidence about the cerebral and cardiac alterations caused by high doses of vitamin D, indicating valuable parameters in the screening and decision-making process for diagnosing patients with symptoms suggestive of intoxication.

A predictive model of progressive chronic kidney disease in idiopathic nephrotic syndrome.

BACKGROUND: There are limited data on the risk factors for chronic kidney disease (CKD) in children with idiopathic nephrotic syndrome (INS). This retrospective cohort study aimed to develop a predictive model for CKD progression in children with INS. METHODS: Between 1970 and 2012, a total of 294 patients with INS were followed up. The primary outcome was progression to CKD stage 3 or higher. A predictive model was developed using a Cox proportional hazards model. A score was calculated using b-coefficients and summing up points assigned to each significant variable. Prognostic score was grouped into categories: low risk, medium risk, and high risk. RESULTS: Median follow-up was 6.9 years. Median renal survival was 26.1 years and probability of CKD stage 3 or higher was 8% in 10 years. Multivariate analysis showed that the most accurate model included initial age, hematuria, and steroid resistance. Accuracy was high with a c-statistic of 0.95 (95% confidence interval [CI] 0.91-0.99), 0.92 (95% CI 0.88-0.96), and 0.92 (95% CI 0.87-0.97) at 2, 5, and 10 years of follow-up respectively. By survival analysis, 10-year renal survival was 100% for the low-risk and 95% for the medium-risk group, while 40% of high-risk patients would exhibit CKD stage 3 or higher (P < 0.001). CONCLUSIONS: Our predictive model of CKD may contribute to the early identification of a subgroup of INS patients at a high risk of renal dysfunction.

Survival of children with sickle cell disease in the comprehensive newborn screening programme in Minas Gerais, Brazil.

BACKGROUND: Children in developing countries with sickle cell disease SCD have high rates of mortality, especially in some parts of Africa. AIM: To compare the 5-year estimated mortality rate in children born between 1999 and 2001 with that of children born between 2009 and 2011. METHODS: During the period 1998-2012, sickle cell disease was diagnosed in 2591 of 3,617,919 newborns screened in Minas Gerais, Brazil (1 : 1,400). The estimated probability of death [1 - Survival] was calculated by the Kaplan-Meier method. The logrank test was used to compare groups of survival data. RESULTS: Of the 2576 children (15 were excluded), 193 died (7.4%): 153 (79.3%) had SS/Sß(0)-thalassaemia, 34 had SC (17.6%), and six (3.1%) had Sß(+) thalassaemia. The 5-year estimated mortality was lower for children born between 2009 and 2011 (n=509) than for those born between 1999 and 2001 (n=624), although not significantly [mean (SD) 5.8% (1.1) vs 6.2% (1.0)], respectively). CONCLUSION: Despite an effective ongoing comprehensive screening programme, mortality from SCD in Minas Gerais is still high. To decrease mortality rates, socio-economic development and SCD education programmes for health professionals and families are required.