MANIFESTĂRILE TUBULUI DIGESTIV SUPERIOR LA PACIENTUL CU IRC DIALIZAT

Introducere: bolnavii cu IRC sunt susceptibili la o gamă largă de complicaţii: refl ux gastro-esofagian, esofagită, gastropatie, gastrită şi duodenită, ulcer gastric şi duodenal, angiodisplazie. Obiective: studiul a constat în evidenţierea simptomelor gastro-duodenale, a frecvenţei modifi cărilor patologice ale mucoasei eso-gastro-duodenale şi a prezenţei H.pylori la copiii cu IRC afl aţi în program de dializă. Material şi metodă: lotul de studiu a fost format din 55 de copii internaţi în Clinica a IV-a Nefrologie, afl aţi în program de substituţie renală cronică, la care s-a aplicat un protocol ce a sistematizat: simptomele obiective şi subiective şi rezultatele endoscopiei digestive superioare. Lotul cuprinde bolnavii cu modifi cări ale mucoasei depistate endoscopic. Concluzii: modifi cările patologice ale mucoasei eso-gastro-duodenale la copilul dializat cronic se refl ectă clinic inconstant, ceea ce sugerează necesitatea endoscopiei pentru fi ecare caz. Prezenţa H.pylori la 24/55 (43,63%) cazuri biopsiate evidenţiază asocierea relativ frecventă între leziunile gastro-duodenale şi H.pylori la pacienţii dializaţi cronic

Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis : A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network

While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.Peer reviewe

MYCOFENOLATUL DE MOFETIL VERSUS CICLOFOSFAMIDA ÎN SINDROMUL NEFROTIC CORTICOREZISTENT LA COPII

Managementul pacienţilor cu sindrom nefrotic corticorezistent (SNCR) este difi cil. Vom prezenta experienţa noastrǎ în tratamentul cu Mycofenolat de mofetil versus Ciclofosfamidǎ, într-o analizǎ retrospectivǎ a 54 de cazuri cu sindrom nefrotic corticoresistent idiopatic cu aspecte histologice diferite. Rata remisiunii complete şi susţinute a fost de 50% pentru Mycofenolat, ceea ce confi rmǎ efi cienţa tratamentului, aceastǎ ratǎ fi ind mai mare decât în tratamentul cu Ciclofosfamidǎ (39,53%)

Attachment quality and psychopathological symptoms in clinically referred adolescents : the mediating role of early maladaptive schema

This study investigated relationships between attachment insecurity, maladaptive cognitive schemas, and various types of psychopathological symptoms in a sample of clinically referred adolescents (N = 82). A mediation model was tested in which maladaptive schemas operated as mediators in the relations between indices of attachment quality and conduct, peer, and emotional problems. Results revealed partial support for the hypothesized mediation effect: the schema domain of disconnection/rejection acted as a mediator in the links between insecure attachment and peer problems and emotional problems. Further analysis of these effects revealed that different types of maladaptive schemas were involved in both types of psychopathology. Altogether, findings suggest that treatment of adolescent psychological problems may need to target the improvement of attachment relationships with peers and parents and the correction of underlying cognitive schemas

The Relation Between Attachment and Depression in Children and Adolescents: A Multilevel Meta-Analysis

Insecure attachment to primary caregivers is associated with the development of depression symptoms in children and youth. This association has been shown by individual studies testing the relation between attachment and depression and by meta-analyses focusing on broad internalizing problems instead of depression or adult samples only. We therefore meta-analytically examined the associations between attachment security and depression in children and adolescents, using a multilevel approach. In total, 643 effect sizes were extracted from 123 independent samples. A significant moderate overall effect size was found (r = .31), indicating that insecure attachment to primary caregivers is associated with depression. Multivariate analysis of the significant moderators that impacted on the strength of the association between attachment security and depression showed that country of the study, study design, gender, the type of attachment, and the type of instrument to assess attachment uniquely contributed to the explanation of variance. This study suggests that insecure attachment may be a predictor of the development of depression in children and adolescents. When treating depression in children, attachment should therefore be addressed