Mycophenolate mofetil in children with steroid/cyclophosphamide-resistant nephrotic syndrome.

The purpose of this study was to assess the results of therapy with mycophenolate mofetil (MMF) in children with idiopathic nephrotic syndrome (INS) who were both steroid- and cyclophosphamide-resistant. Treatment lasted a minimum of 6 months, and follow-up data were collected over a 2-year period. The children were divided into two groups: Group 1 (n=34) comprised patients who had received cyclosporine A (CsA) before the initiation of MMF therapy; Group 2 (n=18) comprised patients who received only MMF. Among the 34 patients of Group 1, complete and partial remission were achieved in seven (20.6%) and 13 patients (38.6%), respectively; there was no response in 14 patients (41.2%). Among the 18 patients in Group 2, complete and partial remission occurred in five (27.8%) and six (33.3%) patients, respectively; there was no response in seven patients (38.9%). Eight patients developed chronic kidney disease. The main side-effects were gastrointestinal complaints (n=11, 21%), recurring severe infections (n=1, 1.9%), and mild thrombocytopenia/leucopenia (n=1, 1.9%). MMF proved to be therapeutically effective in 59.5% of the cases. These beneficial effects need to be confirmed in studies with a long-term follow-up after discontinuation of the treatment. Our statistical analysis of the results of therapy with MMF did not reveal any significant difference between its use alone or following CsA administration.

Antipyretic effect of ibuprofen and dipyrone in febrile children.

OBJECTIVE: To evaluate temperature changes in febrile children that received a single oral dose of ibuprofen (10 mg/kg), the dose recommended for high fever, or dipyrone (15 mg/kg), the dose recommended by the manufacturer, at 2, 3, 4, 5, 6, 7 and 8 hours after administration. METHODS: This open-label randomized (1:1) controlled clinical tried enrolled 80 febrile boys and girls aged 6 months to 8 years with baseline axillary temperatures of 38.0 to 40.3 °C. The children were divided into two groups: high fever (> 39.1 °C) and low-grade fever (38.0 to 39.1 °C). The antipyretic effect was analyzed according to discontinuity, safety, response to treatment, tolerability and therapeutic efficacy. RESULTS: Of the 80 children, 31 remained febrile during the 8 hours (38.8%), but 100% had a temperature decrease in the first 2 hours after the administration of either medication. In the high fever group, the temperature fell in 11 children treated with ibuprofen up to the 5th hour (100.00%) and in the 11 that received dipyrone, up to the third hour (100.00%). The difference in antipyretic efficacy of ibuprofen in the high fever group was statistically significant in the 3rd and 4th hours, and in the low-grade fever group, in the 3rd hour after medication. CONCLUSIONS: A single oral dose of ibuprofen has a greater antipyretic efficacy than dipyrone, particularly when the fever is high. Both drugs were well tolerated and safe in the short term.

Comportamento dos antitérmicos ibuprofeno e dipirona em crianças febris / Antipyretic effect of ibuprofen and dipyrone in febrile children

OBJETIVO: Analisar o comportamento da temperatura em crianças febris medicadas com dose oral única do ibuprofeno (10 mg/kg), dose recomendada para febre alta, comparado à dipirona (15 mg/kg), dose preconizada pelo fabricante, após 2, 3, 4, 5, 6, 7 e 8 horas da medicação antitérmica. MÉTODOS: Ensaio clínico, aberto e randomizado (1:1), em crianças de ambos os sexos, com doenças febris, com idade entre 6 meses e 8 anos, temperatura axilar basal entre 38,0 e 40,3 °C, e divididas em dois grupos: febre alta (> 39,1 °C) e febre baixa (38,0 a 39,1 °C). A análise do comportamento baseou-se nos critérios de descontinuidade, segurança, resposta ao tratamento, tolerabilidade e eficácia terapêutica. RESULTADOS: Das 80 crianças, 31 permaneceram afebris ao longo de 8 horas (38,8 por cento), 100,0 por cento obtiveram decréscimo da temperatura com ambas as medicações nas 2 primeiras horas. No grupo de febre alta, 11 crianças medicadas com ibuprofeno foram mantidas até a 5ª hora (100,0 por cento), e 11 com dipirona até a 3ª hora (100,0 por cento). A eficácia antipirética na febre alta foi estatisticamente significante a favor do ibuprofeno na 3ª e na 4ª hora, e, na febre baixa, na 3ª hora após a medicação. CONCLUSÕES: Este estudo demonstrou que, em dose oral única, o ibuprofeno proporciona atividade antipirética mais acentuada do que a dipirona, principalmente na febre alta. Ambas as medicações foram bem toleradas e seguras em curto prazo.

OBJECTIVE: To evaluate temperature changes in febrile children that received a single oral dose of ibuprofen (10 mg/kg), the dose recommended for high fever, or dipyrone (15 mg/kg), the dose recommended by the manufacturer, at 2, 3, 4, 5, 6, 7 and 8 hours after administration. METHODS: This open-label randomized (1:1) controlled clinical tried enrolled 80 febrile boys and girls aged 6 months to 8 years with baseline axillary temperatures of 38.0 to 40.3 °C. The children were divided into two groups: high fever (> 39.1 °C) and low-grade fever (38.0 to 39.1 °C). The antipyretic effect was analyzed according to discontinuity, safety, response to treatment, tolerability and therapeutic efficacy. RESULTS: Of the 80 children, 31 remained febrile during the 8 hours (38.8 percent), but 100 percent had a temperature decrease in the first 2 hours after the administration of either medication. In the high fever group, the temperature fell in 11 children treated with ibuprofen up to the 5th hour (100.00 percent) and in the 11 that received dipyrone, up to the third hour (100.00 percent). The difference in antipyretic efficacy of ibuprofen in the high fever group was statistically significant in the 3rd and 4th hours, and in the low-grade fever group, in the 3rd hour after medication. CONCLUSIONS: A single oral dose of ibuprofen has a greater antipyretic efficacy than dipyrone, particularly when the fever is high. Both drugs were well tolerated and safe in the short term.