Calidad de vida de los hermanos de pacientes con enfermedad crónica / Quality of life among siblings of patients with chronic conditions

Introducción. La calidad de vida relacionada con la salud (CVRS) es una medida de resultado de salud. Evalúa el impacto subjetivo y global de las enfermedades en la vida cotidiana. Brinda información multidimensional sobre el bienestar físico, relación familiar y sus pares. Los estudios de CVRS de hermanos son limitados.Objetivo. Comparar CVRS de los hermanos de pacientes pediátricos con patologías reumáticas crónicas, trasplante renal o hepático con la de niños sanos con hermanos sin enfermedades crónicas.Resultados. Se compararon hermanos de niños con trasplante renal (n: 65), trasplante hepático (n: 35) y patologías reumáticas crónicas (n: 36) con el grupo control de niños sanos (n: 51). El grupo total de hermanos tuvieron puntuación más baja, estadísticamente significativa, en las dimensiones bienestar físico, amigos-apoyo social y recursos económicos. Los hermanos de trasplante renal tuvieron baja puntuación en las dimensiones de bienestar físico (p < 0,02; tamaño del efecto ­TE­: 0,66) y recursos económicos (p < 0,01; TE: 0,66). Los hermanos de trasplante hepático percibieron menor bienestar físico (p = 0,04), tenían menos amigos y apoyo social (p < 0,01), dificultades en el entorno escolar (p < 0,02) y recursos económicos (p < 0,01). Los hermanos de patologías reumáticas crónicas tuvieron menor bienestar físico (p < 0,05; TE: 0,44) y apoyo social-amigos (p < 0,01; TE: 0,58).Conclusión. La CVRS de niños/as sanos de hermanos con patologías crónicas es menor en bienestar físico, amigos-apoyo social y recursos económicos comparada con el grupo de niños sanos.

Introduction. Health-related quality of life (HRQoL) is a measure of health outcomes. It assesses the subjective and overall impact of diseases on daily life. It also provides multidimensional data about physical well-being, family and peers relations. HRQoL studies on siblings are limited.Objective. To compare HRQoL among siblings of pediatric patients with chronic rheumatic diseases, kidney or liver transplant and healthy children whose siblings had no chronic conditions.Results. The siblings of children with kidney transplant (n: 65), liver transplant (n: 35), and chronic rheumatic diseases (n: 36) were compared to the healthy children group (n: 51). The total siblings group had a lower, statistically significant score in the physical well-being, social support and peers, and financial resources dimensions. The siblings of kidney transplant patients had a low score in the physical well-being (p < 0.02; effect size [ES]: 0.66) and financial resources (p < 0.01; ES: 0.66) dimensions. The siblings of liver transplant patients perceived a lower physical well-being (p = 0.04), less social support and peers(p < 0.01), and difficulties in relation to school environment (p < 0.02) and financial resources (p < 0.01). The siblings of those with chronic rheumatic diseases had a lower score in the physical well-being (p < 0.05; ES: 0.44) and social support and peers (p < 0.01; ES: 0.58) dimensions.Conclusion. HRQoL among healthy children whose siblings have a chronic disease was lower in the physical well-being, social support and peers, and financial resources dimensions compared to the healthy children group.

Quality of life among siblings of patients with chronic conditions. / Calidad de vida de los hermanos de pacientes con enfermedad crónica.

INTRODUCTION: Health-related quality of life (HRQoL) is a measure of health outcomes. It assesses the subjective and overall impact of diseases on daily life. It also provides multidimensional data about physical wellbeing, family and peers relations. HRQoL studies on siblings are limited. OBJECTIVE: To compare HRQoL among siblings of pediatric patients with chronic rheumatic diseases, kidney or liver transplant and healthy children whose siblings had no chronic conditions. RESULTS: The siblings of children with kidney transplant (n: 65), liver transplant (n: 35), and chronic rheumatic diseases (n: 36) were compared to the healthy children group (n: 51). The total siblings group had a lower, statistically significant score in the physical well-being, social support and peers, and financial resources dimensions. The siblings of kidney transplant patients had a low score in the physical wellbeing (p < 0.02; effect size [ES]: 0.66) andfinancial resources (p < 0.01; ES: 0.66) dimensions. The siblings of liver transplant patients perceived a lower physical well-being (p = 0.04), less social support and peers (p < 0.01), and difficulties in relation to school environment (p < 0.02) and financial resources (p <0.01). The siblings of those with chronic rheumatic diseases had a lower score in the physical well-being (p < 0.05; ES: 0.44) and social support and peers (p <0.01; ES: 0.58) dimensions. CONCLUSION: HRQoL among healthy children whose siblings have a chronic disease was lower in the physical well-being, social support and peers, and financial resources dimensions compared to the healthy children group.

Introducción. La calidad de vida relacionada con la salud (CVRS) es una medida de resultado de salud. Evalúa el impacto subjetivo y global de las enfermedades en la vida cotidiana. Brinda información multidimensional sobre el bienestar físico, relación familiar y sus pares. Los estudios de CVRS de hermanos son limitados. Objetivo. Comparar CVRS de los hermanos de pacientes pediátricos con patologías reumáticas crónicas, trasplante renal o hepático con la de niños sanos con hermanos sin enfermedades crónicas. Resultados. Se compararon hermanos de niños con trasplante renal (n: 65), trasplante hepático (n: 35) y patologías reumáticas crónicas (n: 36) con el grupo control de niños sanos (n: 51). El grupo total de hermanos tuvieron puntuación más baj a, estadísticamente significativa, enlas dimensiones bienestar físico, amigos-apoyo social y recursos económicos. Los hermanos de trasplante renal tuvieron baja puntuación en las dimensiones de bienestar físico (p < 0,02; tamaño del efecto -TE-: 0,66) y recursos económicos (p < 0,01; TE: 0,66). Los hermanos de trasplante hepático percibieron menor bienestar físico (p = 0,04), tenían menos amigos y apoyo social (p < 0,01), dificultades en el entorno escolar (p < 0,02) y recursos económicos (p < 0,01). Los hermanos de patologías reumáticas crónicas tuvieron menor bienestar físico (p < 0,05; TE: 0,44) y apoyo social-amigos (p < 0,01; TE: 0,58). Conclusión. La CVRS de niños/as sanos de hermanos con patologías crónicas es menor en bienestar físico, amigos-apoyo social y recursos económicos comparada con el grupo de niños sanos.

Health-related quality of life among siblings of kidney transplant recipients.

Studies are increasingly recognizing health-related quality of life (HRQOL) as a key pediatric outcome in both clinical and research settings and an essential health outcome measure to assess the effectiveness of medical treatment. However, it has not yet been studied among the healthy siblings of kidney transplant recipients. The aim of this study, therefore, is to examine HRQOL among this population. We asked the following three groups to complete a validated measure of HRQOL among children (KIDSCREEN-52): siblings of children who had received kidney transplants (n = 50), kidney transplant recipients (n = 43), and a healthy control group (n = 84). We found that siblings of kidney transplant patients exhibited lower scores for financial resources and autonomy than kidney transplant recipients. They also served lower on physical well-being, financial resources, autonomy, and parent relations/home life than the control group. However, they scored higher on social acceptance than kidney transplant recipients. Our study underscores the importance of assessing HRQOL in families including a child diagnosed with a chronic illness. Siblings require social and psychological support to promote coping and adaptation.

"Removal of nitrate and nitrite by hemodialysis in end-stage renal disease and by sustained low-efficiency dialysis in acute kidney injury".

BACKGROUND & PURPOSE: It is well established that end-stage renal disease (ESRD) is associated with increased cardiovascular morbidity and mortality both in the adult and pediatric population. Although the underlying molecular mechanisms are poorly understood, compromised nitric oxide (NO) bioactivity has been suggested as a contributing factor. With this in mind, we investigated the effects of hemodialysis on NO homeostasis and bioactivity in blood. METHODS & RESULTS: Plasma and dialysate samples were obtained before and after hemodialysis sessions from adults (n = 33) and pediatric patients (n = 10) with ESRD on chronic renal replacement therapy, and from critically ill adults with acute kidney injury (n = 12) at their first sustained low-efficiency dialysis session. Levels of nitrate, nitrite, cyclic guanosine monophosphate (cGMP) and amino acids relevant for NO homeostasis were analyzed. We consistently found that nitrate and cGMP levels in plasma were significantly reduced after hemodialysis, whereas post-dialysis nitrite and amino acids coupled to NO synthase activity (i.e., arginine and citrulline) were only significantly reduced in adults with ESRD. The amount of excreted nitrate and nitrite during dialysis were similar to daily endogenous levels that would be expected from endothelial NO synthase activity. CONCLUSIONS: Our results show that hemodialysis significantly reduces circulating levels of nitrate and cGMP, indicating that this medical procedure may impair NO synthesis and potentially NO signaling pathways.

Alta prevalencia de deficiencia de vitamina D en niños con enfermedad renal crónica y trasplante renal / High prevalence of vitamin D deficiency among children with chronic kidney disease and kidney transplant

Introducción. la deficiencia de vitamina D (25OHD) es muy común en pacientes con enfermedad renal crónica (ERC). Los obj etivos de este trabajo fueron determinar la prevalencia del déficit de 25OHD en niños con ERC e identificar factores de riesgo. Se estableció la correlación entre 25OHD y paratohormona molécula intacta. Población y métodos. Estudio transversal realizado entre enero de 2013 y diciembre de 2015. Se incluyeron pacientes menores de 19 años con y sin ERC. Resultados. Se incluyeron 167 pacientes. Grupo 1 (controles sanos): 32 participantes; grupo 2 (ERC, estadios 2-4, filtrado glomerular entre 89 y 15 ml/min/1,73 m²): 34 pacientes; grupo 3 (estadio 5, en diálisis): 46 pacientes; y grupo 4 (trasplantados renales): 55 pacientes. Presentaron deficiencia de 25OHD 12,5% de los controles sanos y 32% de los pacientes con ERC (p= 0,025). El 23% de los pacientes del grupo 2, el 51% del grupo 3 y el 22% del grupo 4 presentaron deficiencia de 25OHD; el valor medio de 25OHD de los pacientes en diálisis fue significativamente menor que en el resto de los grupos. Los predictores de deficiencia de 25OHD fueron la hipoalbuminemia, ERC avanzada y la procedencia de la región Noroeste. La paratohormona molécula intacta fue significativamente más elevada en el grupo de pacientes con deficiencia y mostró una correlación inversa con los valores de 25OHD. Conclusión. El 32% de los pacientes con ERC presentó deficiencia de 25OHD; en el estadio 5 (diálisis), alcanzó el 51%. Los predictores de deficiencia fueron hipoalbuminemia, ERC avanzada y la procedencia del noroeste.

Introduction. Vitamin D (25(OH)D) deficiency is common among patients with chronic kidney disease (CKD). Our objective was to establish the prevalence of 25(OH)D deficiency among children with CKD and identify risk factors. A correlation was observed between 25(OH)D and parathormone intact molecule. Population and methods. Cross-sectional study conducted between January 2013 and December 2015. Patients younger than 19 years old with and without CKD were included. Results. One hundred and sixty-seven patients were included. Group 1 (healthy controls): 32 participants; group 2 (stage 2-4 CKD, glomerular filtration rate between 89 and 15 mL/min/1.73 m²): 34 patients; group 3 (stage 5 CKD, dialysis): 46 patients; and group 4 (kidney transplant recipients): 55 patients. Deficiency of 25(OH)D was detected in 12.5% of healthy controls and 32% of CKD patients (p= 0.025). Also, 23% of patients in group 2, 51% in group 3, and 22% in group 4 had 25(OH)D deficiency; the mean 25(OH)D level of dialysis patients was significantly lower than that of the rest of the groups. Predictors of 25(OH)D deficiency included hypoalbuminemia, advanced CKD, and place of origin from the Northwest region of Argentina. The parathormone intact molecule was significantly higher in the group of patients with deficiency and was inversely correlated with 25(OH)D levels. Conclusion. Among CKD patients, 32% had 25(OH)D deficiency, which reached 51% among those with stage 5 CKD (dialysis). Predictors of deficiency included hypoalbuminemia, advanced CKD, and place of origin from the Northwest region of Argentina.

Prevalencia y evolución clínica del síndrome urémico hemolítico típico entre hermanos / Prevalence and clinical course of typical hemolytic uremic syndrome among siblings

Introducción. El síndrome urémico hemolítico (SUH) es una entidad infectocontagiosa producida por Escherichia coli productora de toxina Shiga. El objetivo fue evaluar el riesgo de contagio y evolución clinica entre hermanos con SUH típico. Población y métodos. Se analizaron las historias clínicas de los niños con SUH típico desde 1997 a 2012. Se utilizó, como criterio de inclusión, a parejas de hermanos. Se definió un puntaje de gravedad. Resultados. Se registraron 133 pacientes con SUH; 40 tenían hermanos y 4 progresaron a SUH (10%). La edad media de los 4 pares de hermanos fue de 29,3 meses (DE ± 11,5) y 5 (62,5%) eran niñas. El tiempo medio entre casos fue de 5,7 días (DE ± 3). El SUH presentó un mayor puntaje de gravedad en los hermanos que se enfermaron en segundo lugar. Conclusión. El riesgo para desarrollar SUH entre hermanos fue 10% y la evolución clínica del segundo hermano fue más desfavorable.

Introduction. Hemolytic uremic syndrome (HUS) isaninfectious disease caused by Shiga toxin-producing Escherichia coli. The objective of this study was to assess the risk of transmission and clinical course between siblings with typical HUS. Population and methods. Medical records of children with typical HUS between 1997 and 2012 were reviewed. Sibling pairs were established as inclusion criteria. A severity score was defined. Results. A total of 133 patients with HUS were recorded; 40 had siblings and 4 progressed to HUS (10%). The mean age of the 4 sibling pairs was 29.3 months old (SD ± 11.5); 5 (62.5%) were girls. The mean time between each case was 5.7 days (SD ± 3). HUS was more severe in the siblings who became infected in the second place. Conclusion. The risk of HUS transmission between siblings was 10%, and the clinical course of the second sibling was less favorable.

Prevalence and clinical course of typical hemolytic uremic syndrome among sibling. / Prevalencia y evolución clínica del síndrome urémico hemolítico típico entre hermanos.

INTRODUCTION: Hemolytic uremic syndrome (HUS) isaninfectious disease caused by Shiga toxin-producing Escherichia coli. The objective of this study was to assess the risk of transmission and clinical course between siblings with typical HUS. POPULATION AND METHODS: Medical records of children with typical HUS between 1997 and 2012 were reviewed. Sibling pairs were established as inclusion criteria. A severity score was defined. RESULTS: A total of 133 patients with HUS were recorded; 40 had siblings and 4 progressed to HUS (10%). The mean age of the 4 sibling pairs was 29.3 months old (SD ± 11.5); 5 (62.5%) were girls. The mean time between each case was 5.7 days (SD ± 3). HUS was more severe in the siblings who became infected in the second place. CONCLUSION: The risk of HUS transmission between siblings was 10%, and the clinical course of the second sibling was less favorable.

INTRODUCCIÓN: El síndrome urémico hemolítico (SUH) es una entidad infectocontagiosa producida por Escherichia coli productora de toxina Shiga. El objetivo fue evaluar el riesgo de contagio y evolución clinica entre hermanos con SUH típico. POBLACIÓN Y MÉTODOS: Se analizaron las historias clínicas de los niños con SUH típico desde 1997 a 2012. Se utilizó, como criterio de inclusión, a parejas de hermanos. Se definió un puntaje de gravedad. RESULTADOS: Se registraron 133 pacientes con SUH; 40 tenían hermanos y 4 progresaron a SUH (10%). La edad media de los 4 pares de hermanos fue de 29,3 meses (DE ± 11,5) y 5 (62,5%) eran niñas. El tiempo medio entre casos fue de 5,7 días (DE ± 3). El SUH presentó un mayor puntaje de gravedad en los hermanos que se enfermaron en segundo lugar. CONCLUSIÓN: El riesgo para desarrollar SUH entre hermanos fue 10% y la evolución clínica del segundo hermano fue más desfavorable.

Invaginación intestinal en un lactante con diagnóstico de botulismo: Reporte de un caso / Intussusception in infant with diagnostic botulism: A case report

El botulismo es un importante problema de salud pública en Argentina. Es una enfermedad potencialmente letal y de difícil diagnóstico. Existen casos de presentación infrecuente de dicha enfermedad, como el abdomen agudo. Exponemos el caso de un niño de 4 meses, que consultó por constipación de 3 días de evolución, asociada a decaimiento y regular actitud alimentaria de 12 horas de evolución. Presentaba tono muscular conservado, sin alteraciones en la succión ni deglución, según la referencia materna. Se constató sensorio alternante y abdomen agudo, por lo que ingresó a quirófano con sospecha de invaginación intestinal, la cual fue confirmada mediante desinvaginación neumática. Durante la internación, el paciente evolucionó desfavorablemente y presentó llanto débil, hipotonía progresiva e insuficiencia respiratoria, por lo que requirió cuidados intensivos. Se aisló Clostridium botulinum en la muestra de materia fecal y toxina botulínica tipo A en el suero. Recibió toxina antibotulínica equina como tratamiento, con recuperación total a los 25 días de haber ingresado.

Botulism is an important public health problem in Argentina. It is a potentially fatal disease, and its diagnosis may be difficult. There are rare presentation forms of the disease, such as acute abdomen. We present a 4-monthbaby with a 3-day constipation condition, associated with weakness and abnormal eating attitude in the last 12 hours. The baby presented preserved muscle tone, with no changes in sucking or deglutition according to the mother's observations. Altered sensorium and acute abdomen were found; the patient was entered into the operating room with presumptive diagnosis ofintussusception, which was confirmed by pneumatic desinvagination. During hospitalization, the patient did not make good progress and presented weak cry, progressive hypotonia and respiratory failure requiring intensive care. Clostridium botulinum was isolated from the stool sample and botulinum toxin type A was isolated from serum. The patient was treated with equine botulinum toxin. Twenty five days after admission, he was totally recovered.

Invaginación intestinal en un lactante con diagnóstico de botulismo: Reporte de un caso / Intussusception in infant with diagnostic botulism: A case report

El botulismo es un importante problema de salud pública en Argentina. Es una enfermedad potencialmente letal y de difícil diagnóstico. Existen casos de presentación infrecuente de dicha enfermedad, como el abdomen agudo. Exponemos el caso de un niño de 4 meses, que consultó por constipación de 3 días de evolución, asociada a decaimiento y regular actitud alimentaria de 12 horas de evolución. Presentaba tono muscular conservado, sin alteraciones en la succión ni deglución, según la referencia materna. Se constató sensorio alternante y abdomen agudo, por lo que ingresó a quirófano con sospecha de invaginación intestinal, la cual fue confirmada mediante desinvaginación neumática. Durante la internación, el paciente evolucionó desfavorablemente y presentó llanto débil, hipotonía progresiva e insuficiencia respiratoria, por lo que requirió cuidados intensivos. Se aisló Clostridium botulinum en la muestra de materia fecal y toxina botulínica tipo A en el suero. Recibió toxina antibotulínica equina como tratamiento, con recuperación total a los 25 días de haber ingresado.(AU)

Botulism is an important public health problem in Argentina. It is a potentially fatal disease, and its diagnosis may be difficult. There are rare presentation forms of the disease, such as acute abdomen. We present a 4-monthbaby with a 3-day constipation condition, associated with weakness and abnormal eating attitude in the last 12 hours. The baby presented preserved muscle tone, with no changes in sucking or deglutition according to the mothers observations. Altered sensorium and acute abdomen were found; the patient was entered into the operating room with presumptive diagnosis ofintussusception, which was confirmed by pneumatic desinvagination. During hospitalization, the patient did not make good progress and presented weak cry, progressive hypotonia and respiratory failure requiring intensive care. Clostridium botulinum was isolated from the stool sample and botulinum toxin type A was isolated from serum. The patient was treated with equine botulinum toxin. Twenty five days after admission, he was totally recovered.(AU)

[Intussusception in infant with diagnostic botulism: A case report]. / Invaginación intestinal en un lactante con diagnóstico de botulismo: Reporte de un caso.

Botulism is an important public health problem in Argentina. It is a potentially fatal disease, and its diagnosis may be difficult. There are rare presentation forms of the disease, such as acute abdomen. We present a 4-month baby with a 3-day constipation condition, associated with weakness and abnormal eating attitude in the last 12 hours. The baby presented preserved muscle tone, with no changes in sucking or deglutition according to the mother's observations. Altered sensorium and acute abdomen were found; the patient was entered into the operating room with presumptive diagnosis of intussusception, which was confirmed by pneumatic desinvagination. During hospitalization, the patient did not make good progress and presented weak cry, progressive hypotonia and respiratory failure requiring intensive care. Clostridium botulinum was isolated from the stool sample and botulinum toxin type A was isolated from serum. The patient was treated with equine botulinum toxin. Twenty five days after admission, he was totally recovered.

Meningitis por Staphylococcus aureus meticilino resistente proveniente de la comunidad: a propósito de un caso / Methicillin resistant Staphylococcus aureus community acquired meningitis: a case report

Las infecciones por Staphylococcus aureus meticilino resistente adquiridas de la comunidad han aumentado su frecuencia. La mayoría se presenta como infección de piel y partes blandas. Las formas invasivas más frecuentes son las osteoarticulares y pleuropulmonares. Este germen es causa poco frecuente de meningitis. Se presenta un caso infrecuente de infección por Staphylococcus aureus meticilino resistente adquirida de la comunidad. Lactante de 8 meses consulta por irritabilidad y fiebre de 4 días de evolución, con sensorio alternante y abdomen doloroso. Descartándose cuadro quirúrgico, se interna con diagnóstico de sepsis a foco enteral. Los hemocultivos y el cultivo de líquido cefalorraquídeo fueron positivos para Staphylococcus aureus meticilino resistente. Se adecua tratamiento antibiótico y evoluciona favorablemente. Al 7mo día de internación, presenta signos y síntomas neurológicos. En la tomografía computada de alta resolución y en la resonancia magnética, se observanimágenes compatibles con mielitis. El paciente cumple tratamiento endovenoso por 21 días con buena evolución, y se otorga el alta hospitalaria al mes de haberse iniciado el cuadro clínico.

Community-acquired Staphylococcus aureus (CA-SA) infections are becoming more frequent. Most cases present an infection of skin and soft tissue, and the most invasive forms observed are osteoarticular and pleuropulmonary infections. Meningitis is a rare manifestation of Sthapylococcus aureus infections. We describe an unusual case of CA-MRSA infection. An infant of eight months presented with signs of irritability and 4 days duration fever, with alternating sensory and abdomen pain. Acute abdomen surgery was discarded and hospitalization was decided with diagnosis of sepsis due to probable enteral focus; antibiotics were indicated. Blood cultures and cerebrospinal fluid culture were positive for MRSA. Sepsis with meningitis by MRSA was diagnosed. On the 7th day of hospitalization the infant presented neurological signs and symptoms. On the resolution computed tomography and the magnetic resonance, images compatible with myelitis were observed. The patient complied with the 21 day endovenous treatment, and showed positive results, being discharged from hospital a month after the appearance of the symptoms.

Meningitis por Staphylococcus aureus meticilino resistente proveniente de la comunidad: a propósito de un caso / Methicillin resistant Staphylococcus aureus community acquired meningitis: a case report

Las infecciones por Staphylococcus aureus meticilino resistente adquiridas de la comunidad han aumentado su frecuencia. La mayoría se presenta como infección de piel y partes blandas. Las formas invasivas más frecuentes son las osteoarticulares y pleuropulmonares. Este germen es causa poco frecuente de meningitis. Se presenta un caso infrecuente de infección por Staphylococcus aureus meticilino resistente adquirida de la comunidad. Lactante de 8 meses consulta por irritabilidad y fiebre de 4 días de evolución, con sensorio alternante y abdomen doloroso. Descartándose cuadro quirúrgico, se interna con diagnóstico de sepsis a foco enteral. Los hemocultivos y el cultivo de líquido cefalorraquídeo fueron positivos para Staphylococcus aureus meticilino resistente. Se adecua tratamiento antibiótico y evoluciona favorablemente. Al 7mo día de internación, presenta signos y síntomas neurológicos. En la tomografía computada de alta resolución y en la resonancia magnética, se observanimágenes compatibles con mielitis. El paciente cumple tratamiento endovenoso por 21 días con buena evolución, y se otorga el alta hospitalaria al mes de haberse iniciado el cuadro clínico.(AU)

Community-acquired Staphylococcus aureus (CA-SA) infections are becoming more frequent. Most cases present an infection of skin and soft tissue, and the most invasive forms observed are osteoarticular and pleuropulmonary infections. Meningitis is a rare manifestation of Sthapylococcus aureus infections. We describe an unusual case of CA-MRSA infection. An infant of eight months presented with signs of irritability and 4 days duration fever, with alternating sensory and abdomen pain. Acute abdomen surgery was discarded and hospitalization was decided with diagnosis of sepsis due to probable enteral focus; antibiotics were indicated. Blood cultures and cerebrospinal fluid culture were positive for MRSA. Sepsis with meningitis by MRSA was diagnosed. On the 7th day of hospitalization the infant presented neurological signs and symptoms. On the resolution computed tomography and the magnetic resonance, images compatible with myelitis were observed. The patient complied with the 21 day endovenous treatment, and showed positive results, being discharged from hospital a month after the appearance of the symptoms.(AU)

[Methicillin resistant Staphylococcus aureus community acquired meningitis: a case report]. / Meningitis por Staphylococcus aureus meticilino resistente proveniente de la comunidad: a propósito de un caso.

Community-acquired Staphylococcus aureus (CA-SA) infections are becoming more frequent. Most cases present an infection of skin and soft tissue, and the most invasive forms observed are osteoarticular and pleuropulmonary infections. Meningitis is a rare manifestation of Staphylococcus aureus infections. We describe an unusual case of CA-MRSA infection. An infant of eight months presented with signs of irritability and 4 days duration fever, with alternating sensory and abdomen pain. Acute abdomen surgery was discarded and hospitalization was decided with diagnosis of sepsis due to probable enteral focus; antibiotics were indicated. Blood cultures and cerebrospinal fluid culture were positive for MRSA. Sepsis with meningitis by MRSA was diagnosed. On the 7th day of hospitalization the infant presented neurological signs and symptoms. On the resolution computed tomography and the magnetic resonance, images compatible with myelitis were observed. The patient complied with the 21 day endovenous treatment, and showed positive results, being discharged from hospital a month after the appearance of the symptoms.

Meningitis por Staphylococcus aureus meticilino resistente proveniente de la comunidad: a propósito de un caso. / [Methicillin resistant Staphylococcus aureus community acquired meningitis: a case report].

Community-acquired Staphylococcus aureus (CA-SA) infections are becoming more frequent. Most cases present an infection of skin and soft tissue, and the most invasive forms observed are osteoarticular and pleuropulmonary infections. Meningitis is a rare manifestation of Staphylococcus aureus infections. We describe an unusual case of CA-MRSA infection. An infant of eight months presented with signs of irritability and 4 days duration fever, with alternating sensory and abdomen pain. Acute abdomen surgery was discarded and hospitalization was decided with diagnosis of sepsis due to probable enteral focus; antibiotics were indicated. Blood cultures and cerebrospinal fluid culture were positive for MRSA. Sepsis with meningitis by MRSA was diagnosed. On the 7th day of hospitalization the infant presented neurological signs and symptoms. On the resolution computed tomography and the magnetic resonance, images compatible with myelitis were observed. The patient complied with the 21 day endovenous treatment, and showed positive results, being discharged from hospital a month after the appearance of the symptoms.

Influence of CYP3A5 polymorphism on tacrolimus maintenance doses and serum levels after renal transplantation: age dependency and pharmacological interaction with steroids.

TAC, MMF and MP are used in pediatric kidney tx. The cytochrome P450 (CYP)3A5 enzyme appears to play a role in TAC metabolism. The aims of this study were to investigate CYP3A5 polymorphism's effect on TAC dosing and the age dependency of TAC dosing by testing blood concentrations, and the interaction between steroids and TAC during the first year after tx. Genomic DNA was extracted and amplified with specific primers. CYP3A5 alleles were confirmed by direct sequencing of PCR products on an automated AB13100 capillary sequencer. We studied 48 renal transplant patients (age at tx 12±0.5yr, 22 boys) receiving TAC, MMF, MP. Of these, 79% were CYP3A5*3/*3 (non-expressers homozygotes) and 21% were CYP3A5*1/*3 (expressers). TAC trough levels were 7.1±0.4ng/mL in CYP3A5*3/*3 patients and 6.5±0.7ng/mL in CYP3A5*1/*3 group (p=0.03). CYP3A5*1/*3 patients had lower levels of dose-adjusted TAC (36.7±5.8ng/mL/mg/kg/day) to achieve target blood concentration and required higher daily dose per weight (0.21±0.03mg/kg/day) than CYP3A5*3/*3 patients, 72.4±8.0ng/mL/mg/kg/day and 0.13±0.01mg/kg/day (p<0.001). Prepubertal patients with different CYP3A5 polymorphisms required significant higher TAC doses and achieved lower dose-normalized concentration compared with pubertal patients. Both TAC dose and adjusted-dose correlated with daily MP dose in CYP3A5*1*3 (r: 0.4, p<0.03 and r: 0.4, p<0.03) and in CYP3A5*3*3 (r: 0.6, p<0.01 and r: 0.47, p<0.001) patients. CYP3A5 polymorphism performed before tx could contribute to a better individualization of TAC therapy. The higher TAC dose in prepubertal patients and the pharmacological interactions between MP and TAC may not be fully explained by different CYP3A5 polymorphisms.

Oxidative stress status during the acute phase of haemolytic uraemic syndrome.

BACKGROUND: Haemolytic uraemic syndrome (HUS) is characterized by haemolytic anaemia, thrombocytopaenia and acute renal failure. The aim of this study was to investigate the levels of oxidative stress (OS) during the acute phase of HUS. METHODS: This prospective study included 18 patients diagnosed with D + HUS, 6 age-matched healthy controls and 29 children with end-stage renal disease (ESRD) not caused by HUS under regular haemodialysis. Plasma lipid peroxidation and non-enzymatic antioxidant defences were measured as thiobarbituric acid-reactive substances (TBARs) and total reactive antioxidant potential (TRAP), respectively, during hospitalization and in control individuals. RESULTS: TBARs were significantly higher in both oliguric and non-oliguric patients at admission (1.8 ± 0.1; 1.7 ± 0.2 µM) and discharge (1.5 ± 0.1; 1.0 ± 0.1 µM) vs controls (0.5 ± 0.1 µM, P < 0.01) following disease progression. Maximal TBARs values differed significantly between oliguric and non-oliguric groups (4.5 ± 0.9 vs 2.4 ± 0.3 µM, P < 0.01) and were significantly higher (P < 0.05) than those found in ESRD patients (1.63 ± 0.1). TRAP values were significantly higher at admission and when the disease was fully established (measured here as highest TBARs record) vs controls (675 ± 51, 657 ± 60 and 317 ± 30 µM Trolox, P < 0.01), and were similar to control values at discharge (325 ± 33 µM Trolox). CONCLUSIONS: We demonstrate here increased levels of OS during the acute phase of HUS, with peak plasma lipid peroxidation values well above those registered in ESRD individuals, and suggest a connection between OS and the clinical course of HUS.

A study on strategies for improving growth and body composition after renal transplantation.

Allograft function and metabolic effects of four treatment regimens, namely, methylprednisone (MP) standard dose (MP-STD), deflazacort (DFZ), MP-late steroid withdrawal (MP-LSW), and MP-very low dose (MP-VLD), were evaluated in prepubertal patients. MP was decreased by month 4 post-transplantation to 0.2 mg/kg/day in MP-STD and DFZ patients and to <0.1 mg/kg/day in MP-LSW and MP-VLD patients. Starting in month 16 post-transplant, MP was switched to DFZ in the DFZ group and totally withdrawn in the MP-LSW group. Creatinine clearance diminished in the MP-STD and MP-LSW groups from 77 +/- 6 to 63 +/- 6 ml/min/1.73 m(2)and from 103 +/- 5 to 78 +/- 3 ml/min/1.73 m(2), respectively (p < 0.01 and p < 0.001, respectively). Height increased >0.5 SDS only in the MP-LSW and MP-VLD groups. The body mass index and fat body mass for height-age increased only in the MP-STD patients (p < 0.05 and p < 0.01, respectively). Fat body mass decreased in the DFZ group (p < 0.05), total cholesterol and LDL-cholesterol increased in the MP-STD group, while LDL-cholesterol and total cholesterol/HDL-cholesterol ratio decreased in the DFZ group (p < 0.01). Lumbar spine bone mineral density (BMD) for height-age showed an increase in the MP-LSW and MP-VLD groups (p < 0.01). Our data suggest that MP-LSW and MP-VLD strategies improve linear growth, BMD, the peripheral distribution of fat, and preservation of the bone-muscle unit and maintain the normal lipid profile. The MP-LSW patients had a concerning rate of acute rejections and graft function deterioration in prepubertal patients.