5 research outputs found
Renal involvement in hypocomplementaemic urticarial vasculitis syndrome : a report of three paediatric cases
OBJECTIVE:
To describe the diagnosis and management of renal disease in three paediatric cases of hypocomplementaemic urticarial vasculitis syndrome (HUVS).
METHODS:
Three children who were diagnosed with HUVS and developed abnormalities of renal function during the disease course are described.
RESULTS:
Urinary findings were heterogeneous: all the patients developed persistent microhaematuria, which was isolated in patient 1, associated with mild proteinuria in patient 2 and with nephrotic syndrome in patient 3. Renal biopsies were performed in all the patients: patients 1 and 2, who had normal levels of serum autoantibodies, shared a full-house IF (C3, C1q and Ig deposits), compatible with an SLE-like disease; patient 3 showed negative staining for IgG and IgM, but developed positive anti-dsDNA without fulfilling criteria for the diagnosis of SLE.
CONCLUSION:
Renal involvement in HUVS is probably more frequent and more severe than in adults and may appear later. Isolated microhaematuria can be the only sign of subclinical renal involvement: its role should not be underestimated and a renal biopsy should be considered. Previous observations of rapidly progressive nephritis and consequent end-stage renal disease in children suggest the need for prompt diagnosis and treatment of renal involvement
The Valsalva manoeuvre versus tourniquet for venipuncture
Background: During ultrasound-guided cannulation, venous filling is required for venipuncture. Tourniquet with an elastic tube at the axilla is the most common method to induce venous stasis for cannulation of the deep veins of the arm. Although effective, this method might be associated with short- and long-term complications. Valsalva manoeuvre has been used to produce venous filling in other extrathoracic veins. The aim of this observational study is to demonstrate the effect of Valsalva manoeuvre in respect of the elastic tourniquet on venous distention during echography-guided cannulation of the deep veins of the arm. Method: Sixty-nine patients scheduled for cannulation of basilic or brachial vein were prospectively observed. Vein diameters were recorded at rest and after 10 s of Valsalva or tourniquet placement. Results: The mean difference between basilic vein diameters during tourniquet and Valsalva manoeuvre was 0.006 mm (95% confidence interval = âinf, 0.09) with a standard deviation of 0.5 mm (95% confidence interval = 0.5, 0.7; p > 0.01). The mean difference between brachial vein diameters during tourniquet and Valsalva manoeuvre was 0.04 mm (95% confidence interval = â0.23, 0.15) with a standard deviation of 0.8 mm (95% confidence interval = 0.7, 0.9; p > 0.01). Discussion: This increase in cross-sectional basilic and brachial vein diameters was not different to that obtained with the elastic tube tourniquet
Renal involvement in hypocomplementaemic urticarial vasculitis syndrome: a report of three paediatric cases
Best practice guidelines for idiopathic nephrotic syndrome : recommendations versus reality
Background: The optimal therapeutic regimen for managing childhood idiopathic nephrotic syndrome (INS) is still under debate. We have evaluated the choice of steroid regimen and of symptomatic treatment adopted by pediatricians and pediatric nephrologists in a large number of centers as the first step towards establishing a shared protocol.Methods: This was a multicenter, retrospective study. A total of 231 children (132 admitted to pediatric units) aged 6\ua0months to <15\ua0years who presented with onset of nephrotic syndrome to 54 pediatric units and six pediatric nephrology units in Italy between 2007 and 2009 were eligible for entry into the study.Results: Median steroid dosing was 55 (range 27\u201375) mg/m2/day. The overall median cumulative dose regimen for the first episode was 3,440 (1,904\u20136,035) mg/m2, and the median duration of the therapeutic regimen was 21 (9\u201348) weeks. The total duration and cumulative steroid dose were significantly higher in patients treated by pediatricians than in those treated by pediatric nephrologists (p = 0.001 and p = 0.008). Among the patient cohort, 55, 64 and 22\ua0% received albumin infusions, diuretics and acetyl salicylic acid treatment, respectively, but the laboratory and clinical data did not differ between children treated or not treated with symptomatic drugs. Albumin and diuretic use did not vary between patients in pediatric units and those in pediatric nephrology units.Conclusions: This study shows major differences in steroid and symptomatic treatment of nephrotic syndrome by pediatricians and pediatric nephrologists. As these differences can influence the efficacy of the treatments and the appearance of side-effects, shared guidelines and their implementation through widespread educational activities are necessary
LâattivitĂ dei Centri Antifumo italiani tra problematiche e aree da potenziare: i risultati di unâindagine svolta attraverso un questionario on-line
Introduzione. In Italia sono 295 i Servizi per la cessazione dal
fumo di tabacco (Centri Antifumo - CA) afferenti al Servizio Sanitario
Nazionale (SSN) censiti nel 2011 dallâOsservatorio Fumo,
Alcol e Droga (OssFAD) dellâIstituto Superiore di SanitĂ . La presente
indagine, condotta dallâOssFAD in collaborazione con i CA,
è stata volta a rilevare alcune delle problematiche con le quali il
personale dei CA si confronta per portare avanti la propria attivitĂ
e le iniziative ritenute utili per migliorarla.
Materiali e metodi. Lâindagine è stata condotta dal 7 al 21
maggio 2012, mediante un questionario compilabile on-line
composto da 5 brevi sezioni di domande con un totale di 38
items da completare. Il link al questionario on-line è stato inviato
per e-mail a 322 indirizzi dei CA censiti nel 2011 dallâOssFAD. I
dati raccolti sono stati elaborati statisticamente con il programma
SPSS 20.
Risultati. Allâindagine hanno risposto 146 operatori dei CA
(45,3%). Sebbene ci siano aspetti ormai consolidati dellâattivitĂ
dei CA, sono ancora molte le criticitĂ che gli operatori riscontrano
nella loro attivitĂ . Le principali problematiche che influiscono
in modo fondamentale/rilevante per la buona attivitĂ
del centro sono le âScarse o nulle risorse economicheâ per il
60,7% del personale, âla mancanza di personale dedicatoâ per
il 52,4% del personale; il âriconoscimento/mandato istituzionale
del CAâ per il 40,9% del personale. Tra le azioni ritenute
piĂš efficaci per facilitare lâaccesso ai CA sono risultate la sensibilizzazione
del personale sanitario (91%), in particolare dei medici
di famiglia e lâinserimento delle prestazioni antitabagiche
nei LEA (76,8%).
Conclusioni. Ă auspicabile che lâattivitĂ dei CA riceva una maggiore
attenzione, attraverso la dotazione di strutture, personale
e finanziamenti adeguati a svolgere un importante ruolo nella
tutela e promozione della salute