Primary membranous nephropathy in children and adolescents: a single-centre report from South Asia.

BACKGROUND: Unlike adults, primary membranous nephropathy (PMN) comprises only 1-2% of childhood nephrotic syndrome. The clinical behaviour of PMN in children is not explicit and we report upon clinical presentation and outcome. METHODS: This prospective study includes children and adolescents (< 20 years) with biopsy-proven PMN without secondary causes. Anti-PLA2R assessment: before and after completing therapy. OUTCOME: percentage of patients achieving remission. RESULTS: Study cohort included 48 (M:F ratio 1.1:1) patients and median age 17 (IQR 15-18) years, with 35 (72.9%) PLA2R related. Median interval from symptom onset to presentation was 5 months, where median proteinuria, serum albumin and creatinine were 4.9 g/day, 2.1 g/dL and 0.63 mg/dL, respectively. Forty-seven patients received immunosuppressive therapy, with various agents used as first-line therapy: cyclical CYC/GC (53.1%), CNI/GC (21.3%), rituximab (14.9%), prednisolone alone (4.3%), azathioprine (4.3%) and mycophenolate mofetil (2.1%). Median follow-up was 29 (14, 59) months. At 6 months, 11 (24.4%) and 17 (37.7%) had complete remission (CR) or partial remission (PR), while at last follow-up (median 29 months), 20 (45.4%) and 14 (31.8%) had CR and PR respectively. No significant differences in outcome were observed with different agents. A total of 60% patients treated with rituximab as first line/for relapsing disease, and all cases with resistant disease receiving rituximab had CR or PR at last follow-up. PLA2R antibody presence was associated with clinical outcome. CONCLUSIONS: Three-quarters of PMN in children and adolescents is PLA2R related and two-thirds respond to immunosuppressive therapy. Rituximab is a promising agent to manage PMN in children. Anti-PLA2R is associated with clinical outcomes.

Wear of an enhanced resin-modified glass-ionomer restorative material.

PURPOSE: To compare the wear of an enhanced resin-modified glass-ionomer (RMGI) restorative material (ACTIVA BioACTIVE Restorative) to a resin composite (Filtek Supreme Ultra), RMGI (Fuji II LC), and glass-ionomer (GI) (Fuji IX) material. METHODS: Specimens of each material (n = 8) were prepared in a silicone mold. All specimens other than the GI material were light polymerized for 40 seconds. After 24-hour storage (H2O, 37 degrees C), the specimens were loaded into the modified Alabama wear testing device. Freshly extracted cusps of human premolars were prepared as antagonists. Specimens were loaded with 20N for 100,000 cycles at 1 Hz. A 33% glycerin lubricant was cycled throughout testing. Specimens and enamel antagonists were scanned before and after wear testing with a non-contact optical profilometer and volumetric wear was measured with superimposition software. Representative specimens were examined with scanning electron microscopy. Data were analyzed with a 1-way ANOVA and Tukey post-hoc analysis (alpha = 0.05). RESULTS: Significant differences were found between materials. Materials ranked in order of increasing wear: Filtek Supreme Ultra and ACTIVA BioACTIVE Restorative < Fuji II LC < Fuji IX. Micrographs revealed that Filtek Supreme Ultra and ACTIVA BioACTIVE Restorative underwent abrasive wear whereas Fuji II LC and Fuji IX underwent fatigue wear.

Effect of scaling and root planing on gingival crevicular fluid levels of adrenomedullin in chronic periodontitis patients with and without diabetes mellitus type 2: A clinico-biochemical study.

Background: Increased plasma adrenomedullin levels are usually observed in certain conditions such as diabetes mellitus (DM). Aims and Objectives: To gauge adrenomedullin values in the gingival crevicular fluid (GCF) of healthy individuals, chronic periodontitis (CP) patients with and without DM, and diabetics without any periodontal involvement, prior and after periodontal therapy. Materials and Methods: A total of 120 subjects were segregated into four categories of 30 each: Group 1 (healthy subjects), Group 2 (CP without DM), Group 3 (patients with CP and DM), and Group 4 (diabetics without any periodontal involvement). GCF was collected from all the patients. Nonsurgical periodontal therapy was done in Group 2 and Group 3 patients, followed up for 6 weeks, and GCF was obtained again from the same site. Enzyme-linked immunosorbent assay was used to evaluate the samples. Results: Adrenomedullin level in the GCF was high in diabetics without any periodontal involvement than in healthy individuals and significantly elevated in those with CP and DM. Reduced adrenomedullin was noted 6 weeks postperiodontal therapy. Conclusion: Adrenomedullin levels being higher in diabetics without any periodontal involvement than healthy controls suggest a link between DM and adrenomedullin. Furthermore, infection plays a noteworthy role in the elevation of adrenomedullin, indicating its role in periodontal disease progression.

RésuméContexte: Des taux plasmatiques d'adrénomédulline accrus sont généralement observés dans certaines conditions telles que le diabète sucré. Buts et objectifs:Évaluer les valeurs de l'adrénomédulline dans le liquide creviculaire gingival (GCF) des individus sains, chroniques parodontite (PC) patients avec et sans DM, et diabétiques sans atteinte parodontale, avant et après traitement parodontal. Matériels et méthodes: Un total de 120 sujets ont été séparés en quatre catégories de 30 chacun: Groupe 1 (sujets sains), groupe 2 (CP sans DM), groupe 3 (patients avec CP et DM) et groupe 4 (diabétiques sans atteinte parodontale). GCF a été collecté de tous les patients. La thérapie parodontale non chirurgicale a été réalisée chez les patients des groupes 2 et 3, suivie pendant 6 semaines et le GCF obtenu à nouveau du même site. Un dosage immunoenzymatique a été utilisé pour évaluer les échantillons. Résultats: taux d'adrénomédulline dans le GCF était élevé chez les diabétiques sans atteinte parodontale que chez les individus sains et significativement élevés chez ceux avec CP et DM. Une réduction de l'adrénomédulline a été notée 6 semaines après la thérapie post-parodontale. Conclusion: les taux d'adrénomédulline étant plus élevés chez les diabétiques sans atteinte parodontale que les contrôles sains suggèrent un lien entre le diabète et l'adrénomédulline. De plus, l'infection joue un rôle rôle important dans l'élévation de l'adrénomédulline, indiquant son rôle dans la progression de la maladie parodontale.

Wear, strength, modulus and hardness of CAD/CAM restorative materials.

OBJECTIVE: To measure the mechanical properties of several CAD/CAM materials, including lithium disilicate (e.max CAD), lithium silicate/zirconia (Celtra Duo), 3 resin composites (Cerasmart, Lava Ultimate, Paradigm MZ100), and a polymer infiltrated ceramic (Enamic). METHODS: CAD/CAM blocks were sectioned into 2.5mm×2.5mm×16mm bars for flexural strength and elastic modulus testing and 4mm thick blocks for hardness and wear testing. E.max CAD and half the Celtra Duo specimens were treated in a furnace. Flexural strength specimens (n=10) were tested in a three-point bending fixture. Vickers microhardness (n=2, 5 readings per specimen) was measured with a 1kg load and 15s dwell time. The CAD/CAM materials as well as labial surfaces of human incisors were mounted in the UAB wear device. Cusps of human premolars were mounted as antagonists. Specimens were tested for 400,000 cycles at 20N force, 2mm sliding distance, 1Hz frequency, 24°C, and 33% glycerin lubrication. Volumetric wear and opposing enamel wear were measured with non-contact profilometry. Data were analyzed with 1-way ANOVA and Tukey post-hoc analysis (alpha=0.05). Specimens were observed with SEM. RESULTS: Properties were different for each material (p<0.01). E.max CAD and Celtra Duo were generally stronger, stiffer, and harder than the other materials. E.max CAD, Celtra Duo, Enamic, and enamel demonstrated signs of abrasive wear, whereas Cerasmart, Lava Ultimate, Paradigm MZ100 demonstrated signs of fatigue. SIGNIFICANCE: Resin composite and resin infiltrated ceramic materials have demonstrated adequate wear resistance for load bearing restorations, however, they will require at least similar material thickness as lithium disilicate restorations due to their strength.