Osteodistrofia renal em criancas renais cronicas mantidas em tratamento conservador

BV UNIFESP: Teses e dissertaçõe

Antibiotic resistance patterns of pediatric community-acquired urinary infections

Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77%. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55% and 51%). The antibiotic resistance rates for E. coli were: nitrofurantoin (6%), nalidixic acid (14%), 1st generation cephalosporin (13%), 3rd generation cephalosporins (5%), aminoglycosides (2%), norfloxacin (9%) and ciprofloxacin (4%). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population

A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study

Background: Pregnancy is a complex time characterised by major transformations in the woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. Indeed, the literature reports how pregnant women experience various psychological symptoms, the most frequent and common of which are symptoms of anxiety, stress, and/or depression. Indeed, promoting a healthy lifestyle focused on a woman's psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological/psychiatric disorders becomes evident. Objective: Our objective was to assess a mindfulness-based mobile app's feasibility, acceptability, and utility. The primary objective of the present research is to explore the feasibility of using a virtual coach, Maia, developed within the Trec Mamma app to promote women's psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective. Methods: The present research is a proof-of-concept study in which a small sample is sufficient to achieve the intended purposes (N=50). Recruitment will occur within the group of pregnant women belonging to the Pregnancy Care Services of the Trento APSS, and the sampling will be convenience sampling. Maia will interact with women for eight weeks, starting from weeks 24/26 of pregnancy. Specifically, there are two sessions per week, which the woman can choose to allow more flexibility towards her needs. Expected results: The psychoeducational pathway is hoped to lead to significant results in terms of usability and engagement in interaction with Maia by women. In addition, there is expected to be an increase in psychological well-being and quality of life. The analysis of the data collected in the present study will be mainly descriptive, oriented toward assessing the achievement of the study objectives. Conclusions: Literature has shown that women during the perinatal period preferred online support, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psycho-educational support for women during pregnancy

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.Santa Casa São Paulo, Dept Pediat, Div Pediat Nephrol, BR-05435000 São Paulo, BrazilSanta Casa São Paulo, Dept Social Med, BR-01221020 São Paulo, BrazilSanta Casa São Paulo, Dept Pathol, BR-01221020 São Paulo, BrazilSanta Casa São Paulo, Dept Pediat, Div Pediat Nephrol, BR-01221020 São Paulo, BrazilWeb of Scienc

Collaborative brazilian pediatric renal transplant registry (CoBrazPed-RTx) : a report from 2004 to 2018

The Brazilian collaborative registry for pediatric renal transplantation began in 2004 as a multicenter initiative aimed at analyzing, reporting, and disseminating the results of pediatric renal transplantation in Brazil. Data from all pediatric renal transplants performed from January 2004 to May 2018 at the 13 participating centers were analyzed. A total of 2744 pediatric renal transplants were performed in the thirteen participating centers. The median age at transplantation was 12.2 years, with the majority being male recipients (56%). The main underlying diseases were CAKUT (40.5%) and glomerulopathy (28%). 1981 (72%) of the grafts were from deceased donors (DD). Graft survival at one year (censored by death) was 94% in the live donor group (LD) and 91% in the DD group (log-rank test P < 0.01). The patient's survival at one and 5 years was 97% and 95% for the LD group and 96% and 93% for the DD group (log-rank test P = 0.02). The graft loss rate was 19% (n = 517), more frequently caused by vascular thrombosis (n = 102) and chronic graft nephropathy (n = 90). DD recipients had 1.6 (1.0-2.2) times greater chance of death and 1.5 (1.2-1.8) times greater chance of graft loss compared to LD recipients. The mortality rate was 5.4% (n = 148), mainly due to infection (n = 69) and cardiovascular disease (n = 28). The results of this collaborative pediatric renal transplant record are comparable to other international registries, although we still have a high infection rate as a cause of death23