Hernia diafragmática congénita de presentación tardía: a propósito de trece casos

Congenital diaphragma..c hernia of late presenta ..on. Report of 13 cases Congenital diaphragma..c hernia (CDH) of late presenta..on is a rare malforma..on in developed countries, being more prevalent in under-development countries. We report 13 pa..ents (from 4 months to 8 years) operated (2006-­-2009) in Afghanistan, Mauritania, Benin and Las Palmas. 11 children had HDC of Bochdalek and 2 Morgagni type. 10 cases debuted with moderate symptoms and the other 3, severe. The predominant symptoms were vomi..ng, dyspnea and growth retarda- ..on. In 10 CDH of Bochdalek diaphragma..c closures proceeded through a laparotomy and one by thoracoscopy. The two Morgagni CDH were operated by laparoscopy. All cases had ini..ally successful outcomes, without significant impact. There was one late death. The incidence of late-onset CDH is higher in developing countries due to lack of symptomatology that accompanies and inadequate implementa ..on of serial check-­-ups to detect problems before they get to important clinical deteriora ..on. Therefore, it is o..en accompanied by malnutri..on and stun..ng. A good predictor is the adapta..on and hypoplas..c lung development.La hernia diafragmá..ca congénita (HDC) de aparición tardía es una malformación poco frecuente en los países desarrollados que, sin embargo, ..ene una mayor incidencia en los países en vía de desarrollo. Presentamos trece pacientes (edad: 4 meses -­- 8 años) tratados quirúrgicamente (período 2006-­-2009) en Afganistán, Mauritania, Benin y Las Palmas. Once niños presentaban HDC de Bochdalek y dos HDC de Morgagni. Diez casos debutaron con sintomatología moderada y los otros tres, grave. La sintomatología predominante fue vómitos, disnea y retraso del crecimiento. En diez HDC de Bochdalek se procedió al cierre diafragmá..co a través de laparotomía y, en una, por toracoscopia. Las dos de Morgagni se intervinieron mediante laparoscopia. Todos los casos evolucionaron, inicialmente, sa..sfactoriamente, sin incidencias significa..- vas. Se registró un fallecimiento tardío. La incidencia de HDC de aparición tardía es superior en paises en via de desarrollo debido a la escasa sintomatología que las acompaña y a la insuficiente implantación de controles pediátricos seriados que permitan detectar los problemas antes que den una sintomatología importante. Por ello, se suelen acompañar de malnutrición y retraso en el crecimiento. Un buen factor pronós..co es la adaptación y e

Serum Creatinine Levels Are Significantly Influenced by Renal Size in the Normal Pediatric Population

Background and objectives Clinical and experimental data have shown that differences in nephron endowment result in differences in renal mass and predisposition to chronic renal failure, hypertension, and proteinuria. We hypothesized that a significant proportion of the variance in GFR, as estimated by serum creatinine, is attributable to differences in renal size in normal children. Design, setting, participants, & measurements A total of 1748 normal renal ultrasounds that were performed in children older than 6 months were reviewed. For each ultrasound, serum creatinine, serum blood urea nitrogen, and systolic and diastolic office BP were recorded. Renal size was evaluated as a function of renal length and thickness. All data were normalized for height, weight, age, and gender. Results When expressed as SD scores, a significant correlation was found between kidney size and serum creatinine (P < 0.0001) and between kidney size and serum blood urea nitrogen (P < 0.002). When dividing kidney size data per quintiles, a difference of 0.51 SD score in serum creatinine was observed between the lowest and highest quintile. No significant correlation was found with office BP measurements. Conclusions These data show that, even in the normal pediatric population, differences in renal function are significantly explained by differences in renal mass. Methodologic limitations of this study are likely to underestimate this relationship. Clin J Am Soc Nephrol 6: 107-113, 2011. doi: 10.2215/CJN.0058011

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols