The Risks of Self - Medication: Case Report of Familial Misuse of AM3 (Immunoferon®)

Over the last decades extended medical knowledge has been an important health care benefit in terms of disease prevention and management. However, probably with no exception, most pharmaceutical products are not devoid of adverse consequences. Immunomodulators are commonly considered a “benign” drug whose advantages bypass consequences. The immunomodulator AM3 (Immunoferon®) is a clinically used, orally administered compound whose active principle is stabilised in an inorganic matrix of calcium. We report the misuse of AM3 in three members of a family; father and two children. The drug was prescribed to the father who subsequently administered it to the children without seeking medical advice. Two months later, all subjects developed abdominal and/or flank colicky pain. Hypercalciuria was diagnosed in the children with different degrees of severity. It is likely that the calcium content of the inorganic matrix played an important role in the onset of symptoms. No adverse side effects related to the inorganic matrix of calcium of immunoferon® have been documented so far. This family case report calls attention to the risks of self -medication in a susceptible family. Paediatric patients are vulnerable as they rely on adults for the supply of medications. Concerning the use of drugs in family, especially nonprescription drugs, the quality of health care provided to the children depends on the health literacy of their parents

Diagnóstico Pré-Natal de Uropatia: Importância do Desenvolvimento Embriológico Renal

As uropatias malformativas constituem a principalcausa de anomalia neonatal nao letal. Estas anomalias do desenvolvimento devem ser interpretadas com base no conhecimento da morbilidade e, em alguns casos, a mortalidade associada a este tipo de patologia 1,2. As malformações congénitas devem ser pensadas com base no conhecimento da dinâmica do normal desenvolvimento embrionário e dos múltiplos factores reguladores intervenientes, so assim será possivel estabelecer estratégias eficazes de investigação e terapêutica

Congenital Solitary Functioning Kidney and Other Associated Congenital Malformations

Introduction: Congenital solitary functioning kidney (CSFK) is associated to other congenital anomalies. Most of them involve urogenital tract, cardiac, skeletal and central nervous system. There are also some syndromes associated to renal malformations. Objective: To determine the prevalence of associated malformations in children with CSFK. Material and methods: We reviewed 134 electronic processes of children with CFSK followed in a terciary department of paediatric nephrology between 2012 and 2016. Results: Ages ranged from neonatal period to 18 years old (6.6±4.4 years). Prenatal diagnosis of solitary kidney was made in 89 cases (66.4%), and agenesia was the etiology in 33.5%. We found 41 children with at least one more malformation (30.6 %). One quarter of children with postnatal diagnosis of CSFK (7/28) had other anomalies. From all children with diagnosis of agenesia, 80% had at least one more malformation, whereas only 30% of other CSFK’s etiology had other anomaly indentified. Urological anomalies were the most frequent (34.1%); however, 27/41 children (65.8%) had at least one malformation of other system, without an urological anomaly. Gastrointestinal anomalies were identified 21.9%, cardiovascular anomalies 19.5%, genital malformations in 19.5%, neurological anomalies in 14.6% and other organ anomalies in 17%. The non-urological congenital malformation more frequent was single umbilical artery (12.2%). Fourteen children (34.1%) had their anomalies included in a syndrome, all them associated with renal anomalies in previous studies. Chronic kidney disease was seen in five of 134 children, three of which with another malformation. Conclusions: This study intends to recall that CSFK may not be the only congenital malformation in a child. It also highlights that there are other anomalies besides urological tract that may be present and must be investigated, especially if there is a diagnosis of true renal agenesia. A good prenatal care and careful follow-up of children with CSFK are essential.info:eu-repo/semantics/publishedVersio

Fanconi Syndrome after Ifosfamide Exposure

ntroduction: Ifosfamide is an antineoplastic drug frequently used in the treatment of pediatric malignancies. However it is responsible for nephrotoxicity in up to 30% of patients, which can be manifested from asymptomatic tubulopathy to overt renal failure. We report a case of a patient who developed Fancony syndrome after exposure to ifosfamide. Clinical Case: A two-year-old caucasian boy was diagnosed with stage IV Burkitt lymphoma with hepatic and renal involvement without central nervous system (CNS) invasion. Baseline evaluation showed GFR of 60 mL/min per 1.73 m2 (Shwartz formula, k=0.143). He underwent five cycles of chemotherapy involving cyclophosphamide, vincristine, prednisolone, doxorubicin, methotrexate and cytarabine. The patient was in remission but three months later relapsed with evidence of involvement of the liver and kidneys on CT. Another course of chemotherapy was initiated with ifosfamide, carboplatin, etoposide, rituximab (R-ICE) and intratecal administration of methotrexate and aracitabine. After five cycles of R-ICE, the patient had a bone marrow transplant. According to protocol, busulfan, cyclophosphamide, tacrolimus, methotrexate, fluconazole and acyclovir were administered. No immediate complications were registered. Four months after transplant, the patient showed significant downward growth percentile crossing and urinalysis suggested tubulopathy. Upon nephrologist referral, laboratory investigations showed GFR 60 mL/min per 1.73 m2, metabolic acidosis, hypouricemia, hypokalemia, hypophosphatemia, glycosuria, proteinuria, high FEUa and FEK, and low GFR of phosphorus. Fancony syndrome was diagnosed and adequate supplementation was initiated. After literature review the most probable causing agent was ifosfamide. After adequate treatment patient’s general condition improved with slow percentile recovery. Conclusions: Nephrotoxicity secondary to chemotherapy is a major cause of morbidity in pediatric cancer survivors. Our case represents a rare situation with unspecific clinical signs. Clinicians must be alert to the necessity of close monitoring to identify renal toxicity as early as possible and allow adequate supplementation, which is crucial in preventing side effects.info:eu-repo/semantics/publishedVersio

Lupus Myelopathy in a Child

A 5-year-old female developed, after a 7-month period of fever, anorexia, weight loss, and a transitory cutaneous erythematous eruption, a severe acute transverse myelopathy, with a partial recovery of motor and sensory function. She had positive antinuclear and antidouble-stranded DNA antibodies but no antiphospholipid antibodies. Six months later she had massive proteinuria and restarted treatment with steroids and cyclophosphamide. Our patient is one of the youngest reported with lupus myelopathy. We discuss the clinical presentation, the magnetic resonance imaging findings, and other relevant laboratory studies of this rare but serious complication of systemic lupus erythematosus

Prenatally Diagnosed Uropathies: Ten Years of Follow-Up

Introdução: As anomalias do tracto urinário são detectadas com uma frequência cada vez maior devido à sistematização da vigilância ecográfica durante a gravidez aliada à sofisticação técnica e à experiência dos ecografistas. Objectivo: Analisar os principais diagnósticos pós-natais investigados na sequência do estudo evolutivo prolongado das uropatias fetais seguidas no ambulatório da nefrologia pediátrica do Hospital de Dona Estefânia. Doentes e Métodos: Estudo retrospectivo dos 392 casos de uropatia fetal observados num período de dez anos e submetidos ao protocolo de investigação em uso na unidade. Resultados: O estudo inclui 362 casos; excluímos 30 processos que não completaram a investigação. A relação sexo masculino: feminino foi de 2: 1. O diagnóstico pré-natal foi realizado em média às 28.9 semanas e a idade média de admissão foi de 68 dias. No estudo evolutivo pós-natal verificou-se a formulação de um diagnóstico definitivo em 349 (96.4%) das crianças. Em 109 crianças (30%) a anomalia fetal foi transitória. Em 75 (20.7%) a dilatação era funcional. Confirmou-se a existência de uropatia em 165/362 crianças: refluxo vesico-ureteral 70/165 (42.4%), displasia multiquística 21%, síndroma da junção pielo-ureteral 16.4%, entre os principais. Nenhum caso evoluiu para insuficiência renal e há a registar, apenas, um caso de hipertensão arterial por poliquistose renal. Conclusão: A planificação da investigação pós-natal reveste-se ainda de alguma controvérsia e continua a evoluir principalmente no grupo das anomalias unilaterais e assintomáticas

Distal Renal Tubular Acidosis and Sensorineural Deafness with Mutation in the ATP6V1B1 Gene

A acidose tubular renal distal é uma doença rara, caracterizada pela incapacidade na acidificação da urina, condicionando acidose metabólica hiperclorémica, hipocaliémia, hipercalciúria e nefrocalcinose, o que poderá causar atraso de crescimento, alteração do metabolismo ósseo e insuficiência renal crónica. A acidose tubular renal distal associada a surdez neurossensorial é uma doença de herança autossómica recessiva, causada por mutações do gene que codifica a subunidade B1 da H+ -ATPase (ATP6V1B1). Os autores relatam os casos de duas irmãs que apresentaram má progressão ponderal, alterações iónicas, do equilíbrio ácido base e surdez neurossensorial. Foi detectada em ambas as crianças a mutação homozigótica no gene ATP6V1B1. Com estes dois casos pretende -se destacar a importância de um diagnóstico precoce nesta patologia rara

Tuberculosis inequalities and socio-economic deprivation in Portugal

OBJECTIVE: To analyse the geographical distribution of tuberculosis (TB) in Portugal and estimate the association between TB and socio-economic deprivation. METHODS: An ecological study at the municipality level using TB notifications for 2010–2014 was conducted. Spatial Bayesian models were used to calculate smoothed standardised notification rates, identify high- and low-risk areas and estimate the association between TB notification and the European Deprivation Index (EDI) for Portugal and its component variables. RESULTS: Standardised notification rates ranged from 4.41 to 76.44 notifications per 100 000 population. Forty-one high-risk and 156 low-risk municipalities were identified. There was no statistically significant association between TB notification rate and the EDI, but some of its variables, such as the proportion of manual workers and the percentage unemployed, were significantly and directly associated with TB notification, whereas the variable ‘proportion of residents with low education level' showed an inverse relationship. CONCLUSION: Wide inequalities in TB notification rates were observed, and some areas continued to exhibit high TB notification rates. We found significant associations between TB and some socio-economic factors of the EDI.This work was supported by contributions from Iceland, Liechtenstein and Norway through the European Economic Area Grants, under the Public Health Initiatives Programme (PT 06, grant number 138DT1)

Understanding the formation of deep eutectic solvents: betaine as a universal hydrogen bond acceptor

© 2020 Wiley-VCH GmbH The mechanism of formation of betaine-based deep eutectic solvents (DES) is presented for the first time. Due to its polarity unbalance, it was found that betaine displays strong negative deviations from ideality when mixed with a variety of different organic substances. These results pave the way for a comprehensive design of novel deep eutectic solvents. A connection to biologically relevant systems was made using betaine (osmolyte) and urea (protein denaturant), showing that these two compounds formed a DES, the molecular interactions of which were greatly enhanced in the presence of water.This work was developed within the scope of the projects CICECO-Aveiro Institute of Materials, UIDB/50011/2020 & UIDP/50011/2020, financed by national funds through the Portuguese Foundation for Science and Technology/MCTES, and CIMO-Mountain Research Center, UIDB/00690/2020, financed by national funds through the FCT/MEC and when appropriate cofinanced by FEDER under the PT2020 Partnership Agreement.info:eu-repo/semantics/publishedVersio

Hypophosphatemic Rickets: A New Mutation

Introduction: Phosphopenic rickets is characterized by hypophosphatemia with hyperphosphaturia, normal calcemia and normal or mildly elevated PTH. This pathology may be caused by mutations in PHEX gene (phosphate regulating endopeptidase homolog X-linked). We present a clinical report of a girl with phosphopenic rickets, as consequence of a new mutation of PHEX gene. Clinical Case: We present a 4-year-old female, with unremarkable family history, who presented with failure to thrive since the first year of life (height at the 5th centile, and with the age of four below 5th centile). Blood tests showed hypophosphatemia (2.4 mg/dL), elevated alkaline phosphatase (495 U/L), normal calcemia, mildly elevated PTH (97.2 pg/mL; RR <68.3) and normal levels of 25(OH)D and 1.25(OH)D vitamins. The radiological study showed bone deformity of the radius and femur. Diagnosis of hypophosphatemic rickets was made and she was medicated with phosphorus and calcitriol. Currently, the patient has no clinical or radiographic signs of rickets, osseous age is according to real age and there was a considerable increase in growth rate (between 25th and 50th centiles). Renal ultrasound shows incipient signs of nephrocalcinosis since she was 9-year-old. The genetic study detected a heterozigous mutation of the PHEX gene: variant c.767_768del (p.Thr256Serfs*7). This variant is not described in the literature or databases. However, since it introduces a premature stop codon that can produce a truncated protein, this is very likely a pathogenic variant. The parent’s genetic study is still in progress. Conclusions: Presently more than 200 mutations in the PHEX gene have been found to cause hypophosphatemic rickets. We describe a new mutation of this gene. Knowledge about new mutations can improve patient’s outcome.info:eu-repo/semantics/publishedVersio