Surveillance biopsies in children post-kidney transplant

Surveillance biopsies are increasingly used in the post-transplant monitoring of pediatric renal allograft recipients. The main justification for this procedure is to diagnose early and presumably modifiable acute and chronic renal allograft injury. Pediatric recipients are theoretically at increased risk for subclinical renal allograft injury due to their relatively large adult-sized kidneys and their higher degree of immunological responsiveness. The safety profile of this procedure has been well investigated. Patient morbidity is low, with macroscopic hematuria being the most common adverse event. No patient deaths have been attributed to this procedure. Longitudinal surveillance biopsy studies have revealed a substantial burden of subclinical immunological and non-immunological injury, including acute cellular rejection, interstitial fibrosis and tubular atrophy, microvascular lesions and transplant glomerulopathy. The main impediment to the implementation of surveillance biopsies as the standard of care is the lack of demonstrable benefit of early histological detection on long-term outcome. The considerable debate surrounding this issue highlights the need for multicenter, prospective, and randomized studies

External validation of multidimensional prognostic indices (ADO, BODEx and DOSE) in a primary care international cohort (PROEPOC/COPD cohort)

Background: Due to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014). Besides, we want to confirm that the prognostic capacity of all indices increases if the number of exacerbations is substituted by the interval between them and to assess the impact on health of the patient''s lifestyle, social network and adherence to treatment. Methods: Design: External validation of scales, open and prospective cohort study in primary care. Setting: 36 health centres in 6 European high, medium and low income countries. Subjects: 477 patients diagnosed with COPD, captured in clinical visit by their General Practitioner/Nurse. Predictors: Detailed patient history, exacerbations, lung function test and questionnaires at baseline. Outcomes: Exacerbations, all-cause mortality and specific mortality, within 5 years of recruitment. Analysis: Multivariate logistic regression and Cox regression will be used. Possible non-linear effect of the indices will be studied by using Structured Additive Regression models with penalised splines. Subsequently, we will assess different aspects of the regression models: discrimination, calibration and diagnostic precision. Clinical variables modulated in primary care and the interval between exacerbations will be considered and incorporated into the analysis. Discussion: The Research Agenda for General Practice/Family Medicine highlights that the evidence on predictive values of prognostic indices in primary care is scarce. A prospective cohort like that of PROEPOC/COPD provides good opportunities for research into COPD and make communication easier between family practitioners, nursing staff, pneumologists and other professionals, supporting a multi-disciplinary approach to the treatment of these patients. Trial registration:ISRCTN52402811. Date: 15/01/2015. Prospectively registered

Cyclosporine-A Induced Gingival Overgrowth

Abstract Background. The link between the gingival overgrowth and cyclosporine pharmacokinetical variables, especially cyclosporine doses which appear to act as stimulator of the gingival proliferative changes, presents a field of interest of large number of researches. The existence of undefined association and/or interaction between the cyclosporine and periodontal variables, could be responsible for this type of gingival overgrowth. The aim of this study was to examine the correlation between the degree of gingival overgrowth, daily doses of cyclosporine A and parodontal parameters. Methods. 120 patients with renal transplants were included in this examination. The cohort was divided into a four groups according to the daily dose of cyclosporine (100, 125, 150, 175 mg). The degree of gingival overgrowth (GOI) was investigated, using a MacGaw index. The plaque index (PI), apical migration, total daily doses of cyclosporine and plasma concentration, was recorded for various groups and a prospective longitudinal follow -up was conducted. Results. Statistically significant correlation was found between GOI and cyclosporine dose ( =0,3; p< 0,01) and also with dental plaque ( = 0,6; p<0,01), gingival inflammation ( =0,3; p<0,01) and lost attachment ( = 0,1; p<0,05). The lost attachment varied significantly between groups, (p<0,05). Gingival inflammation index (GII) also differed among groups with different dose (p<0,01). Our findings showed differences in gingival overgrowth index between groups (p< 0,05). Conclusions. Our results show a positive correlation between gingival overgrowth and pharmacological parameters, especially the high doses (above 175 mg) of cyclosporine and also with parodontal parameters which lead to parodontal destructions. Additionally, we underlined the effect of local factors as a cofactor in the development of this side effect