Comparing Presenting Clinical Features in 48 Children With Microscopic Polyangiitis to 183 Children Who Have Granulomatosis With Polyangiitis (Wegener's) : an ARChiVe Cohort Study

OBJECTIVE: To uniquely classify children with microscopic polyangiitis (MPA), to describe their demographic characteristics, presenting clinical features, and initial treatments in comparison to patients with granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: The European Medicines Agency (EMA) classification algorithm was applied by computation to categorical data from patients recruited to the ARChiVe (A Registry for Childhood Vasculitis: e-entry) cohort, with the data censored to November 2015. The EMA algorithm was used to uniquely distinguish children with MPA from children with GPA, whose diagnoses had been classified according to both adult- and pediatric-specific criteria. Descriptive statistics were used for comparisons. RESULTS: In total, 231 of 440 patients (64% female) fulfilled the classification criteria for either MPA (n\u2009=\u200948) or GPA (n\u2009=\u2009183). The median time to diagnosis was 1.6 months in the MPA group and 2.1 months in the GPA group (ranging to 39 and 73 months, respectively). Patients with MPA were significantly younger than those with GPA (median age 11 years versus 14 years). Constitutional features were equally common between the groups. In patients with MPA compared to those with GPA, pulmonary manifestations were less frequent (44% versus 74%) and less severe (primarily, hemorrhage, requirement for supplemental oxygen, and pulmonary failure). Renal pathologic features were frequently found in both groups (75% of patients with MPA versus 83% of patients with GPA) but tended toward greater severity in those with MPA (primarily, nephrotic-range proteinuria, requirement for dialysis, and end-stage renal disease). Airway/eye involvement was absent among patients with MPA, because these GPA-defining features preclude a diagnosis of MPA within the EMA algorithm. Similar proportions of patients with MPA and those with GPA received combination therapy with corticosteroids plus cyclophosphamide (69% and 78%, respectively) or both drugs in combination with plasmapheresis (19% and 22%, respectively). Other treatments administered, ranging in decreasing frequency from 13% to 3%, were rituximab, methotrexate, azathioprine, and mycophenolate mofetil. CONCLUSION: Younger age at disease onset and, perhaps, both gastrointestinal manifestations and more severe kidney disease seem to characterize the clinical profile in children with MPA compared to those with GPA. Delay in diagnosis suggests that recognition of these systemic vasculitides is suboptimal. Compared with adults, initial treatment regimens in children were comparable, but the complete reversal of female-to-male disease prevalence ratios is a provocative finding

Aspectos clínicos da intoxicação experimental pelas favas de Stryphnodendron fissuratum (Leg. Mimosoideae) em caprinos Clinical aspects of the experimental poisoning by the pods of Stryphnodendron fissuratum (Leg. Mimosoideae) in goats

Com o objetivo de caracterizar o quadro clínico da intoxicação por Stryphnodendron fissuratum Mart. (Leg. Mimosoideae) em caprinos, administraram-se as favas dessa planta a oito caprinos, por via oral forçada em doses únicas e a outros dois caprinos, em doses fracionadas. A menor dose que causou sinais clínicos e morte foi a de 10g/kg. Doses de 20g/kg e 40g/kg causaram sinais acentuados e doses únicas de 5g/kg não provocaram sinais. Doses fracionadas de 5g/kg durante quatro dias, totalizando 20g/kg provocaram sinais acentuados e morte. Em ambos os grupos, os primeiros sinais de intoxicação foram observados a partir do primeiro dia de experimento e a evolução variou de 4-25 dias. A doença caracterizou-se principalmente por alterações digestórias e nervosas que consistiram em anorexia, desidratação, hipomotilidade e atonia ruminal, timpanismo, gemidos constantes, dor à percussão abdominal, fezes com muco, ranger de dentes, apatia, ataxia, dismetria, tremores de cabeça, tremores musculares, fraqueza com o andar cambaleante e trôpego, acentuada depressão e decúbito esternal ou lateral prolongado e morte. Alguns animais apresentaram acentuada queda de pêlos na região dorsal; apenas um caprino apresentou fezes líquidas, marrom-escuras e fétidas. Outros sinais incluíram perda de fluido ruminal durante a ruminação, sialorréia, exsudato nasal seroso e lacrimejamento. As provas de função hepática e renal revelaram alterações discretas. As concentrações séricas de aspartato aminotransferase encontraram-se levemente aumentadas e as de creatinofosfocinase muito aumentadas.<br>In order to confirm the susceptibility of goats to the poisoning by Stryphnodendron fissuratum Mart. (Leg. Mimosoideae) and to characterize the clinical disease, the pods of the plant were given orally to each of eight young goats and in fractioned doses to other two. The lowest lethal dose was 10g/kg. The same dose was the lowest that induced disease. Doses of 20g/kg and 40g/kg caused pronounced clinical signs and doses of 5g/kg did not caused signs. Fractioned doses of 5g/kg during four days also caused pronounced signs. In each groups the first signs of poisoning were observed from the first day of experiments and the changes ranged from 4-25 days. The disease was characterized mainly by digestive and nervous disorders. Clinical signs were partial to complete anorexia, dehydration, decrease in ruminal activity up to atonia, tympanism, constant vocalizations, grinding of the teeth pain up on abdominal palpation, apathy, ataxia, depression, dysmetria, head and muscle tremors, weakness, difficulty in rising, sternal or lateral recumbency and death. Some goats presented extense hair loss in the skin of the dorsum; one goat presented liquid and black fetid feces. Other signs included loss of ruminal fluid during rumination, drooling, serous nasal and ocular discharges. Liver and kidney function tests had resulted in slight changes. AST serum levels were slightly increased and creatine phosphokinase levels were highly increased. These changes can associated to the effects of triterpenic saponins contained in the S. fissuratum pods