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Strain do Átrio Esquerdo pela Técnica de Speckle-Tracking: Contribuição para a Avaliação da Função Diastólica em Pacientes Pediátricos com Doença Renal Crônica SpeckleTracking Speckle Tracking Speckle-Tracking
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Penachio, Flora Maciel
; Diniz, Maria de Fátima Rodrigues
; Laurino, Rosana Sbruzzi Prado
; Watanabe, Andreia
; Sawamura, Karen Saori Shiraishi
; Lianza, Alessandro Cavalcanti
; Menezes, Carolina Rocha Brito
; Silva, Isabela de Sousa Lobo
; Leal, Gabriela Nunes
.
Resumo Fundamento: As complicações cardiovasculares são a principal causa de morte em pacientes pediátricos com doença renal crônica (DRC). A avaliação ecocardiográfica da função diastólica na DRC tem se limitado à avaliação espectral por Doppler espectral e por Doppler tecidual, técnicas sabidamente menos confiáveis na pediatria. O strain do átrio esquerdo (AE) pela técnica do speckle tracking bidimensional (2DST) foi recentemente confirmada como uma medida robusta da função diastólica. Objetivos: Investigar o papel do strain do AE na avaliação da função diastólica de crianças em diferentes estágios da DRC. Métodos: De fevereiro de 2019 a julho de 2022, 55 pacientes com DRC sem sintomas cardiovasculares e 55 controles foram avaliados por ecocardiografia convencional e por ecocardiografia com 2DST. O nível de significância adotado foi de 5% (p < 0,05). Resultados: Pacientes e controles tinham idade similares [9,78 (0,89 – 17,54) vs. 10,72 (1,03 –18,44) anos; p = 0,41] e sexo (36M:19F vs. 34M:21F; p = 0,84) similares. Havia 25 pacientes não dialíticos e 30 pacientes dialíticos. A fração de ejeção do ventrículo esquerdo foi ≥ 55% em todos. Em comparação aos controles, os pacientes com DRC apresentaram strain de reservatório mais baixo (48,22±10,62% vs. 58,52±10,70%) e índice de rigidez do AE mais alto [0,14 (0,08–0,48)%-1 vs. 0,11 (0,06–0,23) %-1]; p<0,0001. A hipertrofia ventricular esquerda associou-se com um strain de reservatório mais baixo (42,05±8,74% vs. 52,99±9,52%), e valores mais altos de índice de rigidez [0,23 (0,11 – 0,48)%-1 vs. 0,13 (0,08–0,23) %-1 e de índice de enchimento do AE (2,39±0,63 cm/s x %-1 vs. 1,74±0,47 cm/s x %-1; p<0,0001). Hipertensão não controlada associou-se com strain de reservatório do AE mais baixo (41,9±10,6% vs. 50,6±9,7; p=0,005). Conclusão: O strain do AE mostrou-se uma ferramenta útil na avaliação de pacientes pediátricos com DRC e associado com fatores de risco cardiovasculares conhecidos. Fundamento . (DRC) tecidual pediatria (AE 2DST DST (2DST Objetivos Métodos 201 2022 5 0,05. 005 0,05 0 05 0,05) Resultados 9,78 978 9 78 [9,7 0,89 089 89 (0,8 17,54 1754 17 54 vs 1072 10 72 10,7 1,03 103 1 03 (1,0 –18,44 1844 18 44 anos 0,41 041 41 36M19F MF 36M 19F M F 34M21F 34M 21F 34M:21F 0,84 084 84 2 3 todos 48,22±10,62% 48221062 48 22 62 (48,22±10,62 58,52±10,70% 58521070 58 52 70 0,14 014 14 [0,1 0,08–0,48%1 0080481 0,08–0,48 % 08 (0,08–0,48)%- 011 11 0,1 0,06–0,23 006023 06 23 (0,06–0,23 %1 %-1] p00001 0001 p<0,0001 associouse associou 42,05±8,74% 4205874 42 8 74 (42,05±8,74 52,99±9,52%, 5299952 52,99±9,52% , 99 52,99±9,52%) 0,23 023 [0,2 (0,1 0,48%1 0481 0,48 0,48)%- 013 13 0,08–0,23 008023 (0,08–0,23 %- 2,39±0,63 239063 39 63 (2,39±0,6 cms cm s 174047 47 1,74±0,4 p<0,0001) 41,9±10,6% 419106 6 (41,9±10,6 50,6±9,7 50697 50 7 p=0,005. p0005 p=0,005 p=0,005) Conclusão mostrouse mostrou conhecidos (DRC 20 202 00 0,0 9,7 97 [9, 0,8 (0, 17,5 175 107 10, 1,0 (1, –18,4 184 4 0,4 04 48,22±10,62 4822106 (48,22±10,6 58,52±10,70 5852107 01 [0, 0,08–0,48% 008048 0,08–0,4 (0,08–0,48)% 0, 0,06–0,2 00602 (0,06–0,2 p0000 000 p<0,000 42,05±8,74 420587 (42,05±8,7 529995 52,99±9,52 0,2 02 0,48% 048 0,48)% 0,08–0,2 00802 (0,08–0,2 2,39±0,6 23906 (2,39±0, 17404 1,74±0, 41,9±10,6 41910 (41,9±10, 50,6±9, 5069 p000 p=0,00 9, [9 (0 17, 1, (1 –18, 48,22±10,6 482210 (48,22±10, 58,52±10,7 585210 [0 00804 0,08–0, (0,08–0,48) 0,06–0, 0060 (0,06–0, p<0,00 42,05±8,7 42058 (42,05±8, 52999 52,99±9,5 0,48) 0080 (0,08–0, 2,39±0, 2390 (2,39±0 1740 1,74±0 41,9±10, 4191 (41,9±10 50,6±9 506 p00 p=0,0 [ ( –18 48,22±10, 48221 (48,22±10 58,52±10, 58521 0,08–0 (0,08–0,48 0,06–0 006 (0,06–0 p<0,0 42,05±8, 4205 (42,05±8 5299 52,99±9, 008 (0,08–0 2,39±0 239 (2,39± 174 1,74± 41,9±10 419 (41,9±1 50,6± p0 p=0, –1 48,22±10 4822 (48,22±1 58,52±10 5852 0,08– (0,08–0,4 0,06– (0,06– p<0, 42,05±8 420 (42,05± 529 52,99±9 (0,08– 2,39± (2,39 1,74 41,9±1 (41,9± 50,6 p=0 48,22±1 482 (48,22± 58,52±1 585 0,08 0,06 (0,06 p<0 42,05± (42,05 52,99± (0,08 2,39 (2,3 1,7 41,9± (41,9 50, p= 48,22± (48,22 58,52± (0,0 p< 42,05 (42,0 52,99 2,3 (2, 41,9 (41, 48,22 (48,2 58,52 42,0 (42, 52,9 2, (2 41, (41 48,2 (48, 58,5 42, (42 52, (4 48, (48 58,
Abstract Background: Cardiovascular complications are the leading cause of mortality in pediatric patients with chronic kidney disease (CKD). Echocardiographic assessment of diastolic function in CKD has been limited to spectral and tissue Doppler imaging, known to be less reliable techniques in pediatrics. Two-dimensional Speckle tracking echocardiography (2DST) derived left atrial (LA) strain has recently been confirmed as a robust measure of diastolic function. Objectives: To investigate LA strain role in diastolic assessment of children at different stages of CKD. Methods: From February 2019 to July 2022, 55 CKD patients without cardiovascular symptoms and 55 controls were evaluated by standard and 2DST echocardiograms. The level of significance was set at 5% (p<0.05). Results: Patients and controls had similar age [9.78 (0.89 – 17.54) vs. 10.72 (1.03 –18,44) years; p = 0.41] and gender (36M:19F vs. 34M:21F; p=0.84). There were 25 non-dialysis patients and 30 dialysis patients. Left ventricular ejection fraction was ≥ 55% in all of them. Comparing CKD and controls, LA reservoir strain was lower (48.22±10.62% vs. 58.52±10.70%) and LA stiffness index was higher [0.14 (0.08–0.48)%-1 vs. 0.11 (0.06–0.23) %-1]; p<0.0001. LV hypertrophy was associated with lower LA reservoir strain (42.05±8.74% vs. 52.99±9.52%), higher LA stiffness [0.23(0.11 – 0.48)%-1 vs. 0.13 (0.08–0.23) %-1 and filling indexes (2.39±0.63 cm/s x %-1 vs. 1.74±0.47 cm/s x %-1; p<0.0001. Uncontrolled hypertension was associated with lower LA reservoir strain (41.9±10.6% vs. 50.6±9.7; p=0.005). Conclusions: LA strain proved to be a feasible tool in the assessment of pediatric CKD patients and was associated with known cardiovascular risk factors. Background . (CKD) imaging pediatrics Twodimensional Two dimensional DST (2DST (LA Objectives Methods 201 2022 5 echocardiograms p<0.05. p005 p<0.05 0 05 (p<0.05) Results 9.78 978 9 78 [9.7 0.89 089 89 (0.8 17.54 1754 17 54 vs 1072 10 72 10.7 1.03 103 1 03 (1.0 –18,44 1844 18 44 years 0.41 041 41 36M19F MF 36M 19F M F 34M21F 34M 21F 34M:21F p=0.84. p084 p=0.84 84 p=0.84) 2 nondialysis non 3 them 48.22±10.62% 48221062 48 22 62 (48.22±10.62 58.52±10.70% 58521070 58 52 70 0.14 014 14 [0.1 0.08–0.48%1 0080481 0.08–0.48 % 08 (0.08–0.48)%- 011 11 0.1 0.06–0.23 006023 06 23 (0.06–0.23 %1 %-1] p00001 0001 p<0.0001 42.05±8.74% 4205874 42 8 74 (42.05±8.74 52.99±9.52%, 5299952 52.99±9.52% , 99 52.99±9.52%) 0.230.11 023011 0.23 [0.23(0.1 0.48%1 0481 0.48 0.48)%- 013 13 0.08–0.23 008023 (0.08–0.23 %- 2.39±0.63 239063 39 63 (2.39±0.6 cms cm s 174047 47 1.74±0.4 41.9±10.6% 419106 6 (41.9±10.6 50.6±9.7 50697 50 7 p=0.005. p0005 p=0.005 005 p=0.005) Conclusions factors (CKD 20 202 p00 p<0.0 (p<0.05 9.7 97 [9. 0.8 (0. 17.5 175 107 10. 1.0 (1. –18,4 184 4 0.4 04 p08 p=0.8 48.22±10.62 4822106 (48.22±10.6 58.52±10.70 5852107 01 [0. 0.08–0.48% 008048 0.08–0.4 (0.08–0.48)% 0. 0.06–0.2 00602 (0.06–0.2 p0000 000 p<0.000 42.05±8.74 420587 (42.05±8.7 529995 52.99±9.52 230 0.230.1 02301 023 0.2 [0.23(0. 0.48% 048 0.48)% 0.08–0.2 00802 (0.08–0.2 2.39±0.6 23906 (2.39±0. 17404 1.74±0. 41.9±10.6 41910 (41.9±10. 50.6±9. 5069 p000 p=0.00 00 p0 p<0. (p<0.0 9. [9 (0 17. 1. (1 –18, p=0. 48.22±10.6 482210 (48.22±10. 58.52±10.7 585210 [0 00804 0.08–0. (0.08–0.48) 0.06–0. 0060 (0.06–0. p<0.00 42.05±8.7 42058 (42.05±8. 52999 52.99±9.5 0.230. 0230 02 [0.23(0 0.48) 0080 (0.08–0. 2.39±0. 2390 (2.39±0 1740 1.74±0 41.9±10. 4191 (41.9±10 50.6±9 506 p=0.0 p<0 (p<0. [ ( –18 p=0 48.22±10. 48221 (48.22±10 58.52±10. 58521 0.08–0 (0.08–0.48 0.06–0 006 (0.06–0 42.05±8. 4205 (42.05±8 5299 52.99±9. 0.230 [0.23( 008 (0.08–0 2.39±0 239 (2.39± 174 1.74± 41.9±10 419 (41.9±1 50.6± p< (p<0 –1 p= 48.22±10 4822 (48.22±1 58.52±10 5852 0.08– (0.08–0.4 0.06– (0.06– 42.05±8 420 (42.05± 529 52.99±9 [0.23 (0.08– 2.39± (2.39 1.74 41.9±1 (41.9± 50.6 (p< 48.22±1 482 (48.22± 58.52±1 585 0.08 0.06 (0.06 42.05± (42.05 52.99± [0.2 (0.08 2.39 (2.3 1.7 41.9± (41.9 50. (p 48.22± (48.22 58.52± 0.0 (0.0 42.05 (42.0 52.99 2.3 (2. 41.9 (41. 48.22 (48.2 58.52 42.0 (42. 52.9 2. (2 41. (41 48.2 (48. 58.5 42. (42 52. (4 48. (48 58.
2.
Podocytopathies associated with familial partial lipodystrophy due to LMNA variants: report of two cases variants
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Morguetti, Maria Julia
; Neves, Precil Diego Miranda de Menezes
; Korkes, Ilana
; Padilha, Wallace Stwart Carvalho
; Jorge, Lectícia Barbosa
; Watanabe, Andreia
; Watanabe, Elieser Hitoshi
; Malheiros, Denise Maria Avancini Costa
; Noronha, Irene de Lourdes
; Dib, Sergio Atala
; Onuchic, Luiz Fernando
; Moisés, Regina S.
.
SUMMARY Lipodystrophies are characterized by complete or selective loss of adipose tissue and can be acquired or inherited. Familial partial lipodystrophy (FPLD) is a hereditary lipodystrophy commonly caused by mutations in the LMNA gene. Herein, we report two cases of FPLD associated with podocytopathies. Patient 1 was diagnosed with FPLD associated with the heterozygous p.Arg482Trp variant in LMNA and had normal glucose tolerance and hyperinsulinemia. During follow-up, she developed nephrotic-range proteinuria. Renal biopsy was consistent with minimal change disease. Patient 2 was diagnosed with FPLD associated with a de novo heterozygous p.Arg349Trp variant in LMNA. Microalbuminuria progressed to macroalbuminuria within 6 years and to nephrotic range proteinuria in the last year. He remained without diabetes and with hyperinsulinemia. Renal biopsy revealed focal segmental glomerulosclerosis not otherwise specified. This report provides further evidence of variable features of lipodystrophy associated with LMNA variants and the importance of long-term follow-up with evaluation of kidney dysfunction. inherited (FPLD gene Herein podocytopathies pArg482Trp pArgTrp p Arg482Trp Arg Trp hyperinsulinemia followup, followup follow up, up nephroticrange disease pArg349Trp Arg349Trp year specified longterm long term dysfunction pArg ArgTrp
3.
O Coração de Pacientes Pediátricos com COVID-19: Novos Insights a Partir de um Estudo Ecocardiográfico Sistemático em um Hospital Terciário no Brasil
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Diniz, Maria de Fátima Rodrigues
; Cardoso, Maira Freire
; Sawamura, Karen Saori Shiraishi
; Menezes, Carolina Rocha Brito
; Lianza, Alessandro Cavalcanti
; Pereira, Maria Fernanda Badue
; Litvinov, Nadia
; Ferranti, Juliana Ferreira
; Forsait, Silvana
; Watanabe, Andreia
; Farhat, Sylvia Costa Lima
; Aikawa, Nadia Emi
; Campos, Lucia Maria Arruda
; Delgado, Artur Figueiredo
; Carneiro-Sampaio, Magda
; Carvalho, Werther Brunow de
; Silva, Clovis Artur
; Leal, Gabriela Nunes
.
Resumo Fundamento A pandemia da COVID-19 representa uma enorme carga para o sistema de saúde do mundo. Apesar de pacientes pediátricos terem sido relativamente poupados em comparação a adultos, estudos recentes mostraram um número crescente de pacientes críticos com Síndrome Inflamatória Multisistêmica Pediátrica (SIM-P) com disfunção cardiovascular importante. No entanto, pouco se conhece a respeito da relação entre anormalidades cardíacas e biomarcadores inflamatórios e de coagulação. Objetivos Investigar anormalidades ecocardiográficas em pacientes pediátricos com COVID-19 admitidos em um hospital terciário. Métodos Este foi um estudo longitudinal retrospectivo, baseado na revisão de prontuários médicos e ecocardiogramas de pacientes (0-19 anos) admitidos em um hospital terciário entre 30 de março e 30 de junho de 2020. Para a análise estatística, o nível de significância foi estabelecido em 5% (p<0,05). Resultados Foram incluídos 48 pacientes, 73% com doenças pré-existentes, 20 (41,7%) com SIM-P. A idade mediana foi 7,5 (0-18,6) anos; 27 (56,2%) eram do sexo masculino. A duração mediana de internação foi 15,4 (2-92) dias e sete (14,6%) pacientes morreram. Um total de 70 ecocardiografias foram realizadas, 66,7% submeteram-se ao exame somente uma vez, e 33,3% várias vezes. Vinte e três (48%) pacientes apresentaram anormalidades no ecocardiograma: oito (16.6%) disfunção sistólica do ventrículo esquerdo, seis (12.5%) disfunção sistólica do ventrículo direito, e 12 (25%) dilatação da artéria coronária (Z-score>+2,5). Anormalidades ecocardiográficas foram significativamente associadas com SIM-P, admissão na unidade de terapia intensiva pediátrica, suporte ventilatório/vasoativo, e morte ( p <0,05). Níveis significativamente mais altos de d-dímero (ng/mL) foram detectados em pacientes com disfunção ventricular esquerda [16733(4157-115668) vs. 2406.5(190-95040)], disfunção ventricular direita [25769(3422-115668) vs. 2803.5(190-95040)] e dilatação da artéria coronária [9652.5(921-115668) vs. 2724(190- 95040)] (p<0,05). Conclusão Anormalidades ecocardiográficas eram frequentes nos pacientes pediátricos com COVID-19 e associadas com piores desfechos clínicos. Exacerbação das vias de inflamação e coagulação pode exercer um importante papel na lesão cardiovascular nesses pacientes.
Abstract Background COVID-19 pandemic represents a huge burden to the health system in the world. Although pediatric COVID-19 patients have been relatively spared compared with adults, recent reports showed an increasing number of critically ill patients with multisystemic inflammatory syndrome in children (MIS-c), with marked cardiovascular impairment. Nevertheless, little is known about the relationship between cardiac abnormalities and inflammatory and coagulation biomarkers. Objectives to investigate echocardiographic abnormalities in pediatric patients with COVID-19 admitted to tertiary hospital. Methods this was a retrospective longitudinal study, based on the review of medical records and echocardiograms of patients (0-19 years) admitted to a tertiary hospital between March 30 and June 30, 2020. For statistical analysis, the significance level was set at 5% (p < 0.05). Results Forty-eight patients were enrolled, 73% with preexisting diseases, 20 (41.7%) with MIS-c. Median age was 7.5 (0-18.6) years; 27 (56.2%) were male. Median duration of hospitalization was 15.4 (2-92) days and seven (14.6%) patients died. A total of 70 echocardiograms were performed; 66.7% patients were scanned only once and 33.3% multiple times. Twenty-three (48%) patients showed echocardiographic abnormalities: eight (16.6%) left ventricle (LV) systolic dysfunction, six (12.5%) right ventricle (RV) systolic dysfunction and 12 (25%) coronary dilatation (Z-score>+2.5). Echocardiographic abnormalities were significantly associated with MIS-c, admission to the pediatric intensive care unit, multiple organ dysfunction, ventilatory/vasoactive support, and death (p<0.05). Significantly higher d-dimer (ng/mL) levels were detected in patients with LV dysfunction [16733(4157-115668) vs. 2406.5(190-95040)], RV dysfunction [25769(3422-115668) vs. 2803.5(190-95040)] and coronary artery dilation [9652.5(921-115668) vs. 2724(190- 95040)] (p<0.05). Conclusion Echocardiographic abnormalities in COVID-19 pediatric patients were frequent and associated with worse clinical outcomes. Exacerbation of the inflammation and coagulation pathways may play an important role in cardiovascular injury in those patients.
https://doi.org/10.36660/abc.20200920
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4.
Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
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Fink, Thais T.
; Marques, Heloisa H.S.
; Gualano, Bruno
; Lindoso, Livia
; Bain, Vera
; Astley, Camilla
; Martins, Fernanda
; Matheus, Denise
; Matsuo, Olivia M.
; Suguita, Priscila
; Trindade, Vitor
; Paula, Camila S.Y.
; Farhat, Sylvia C.L.
; Palmeira, Patricia
; Leal, Gabriela N.
; Suzuki, Lisa
; Odone Filho, Vicente
; Carneiro-Sampaio, Magda
; Duarte, Alberto José S.
; Antonangelo, Leila
; Batisttella, Linamara R.
; Polanczyk, Guilherme V.
; Pereira, Rosa Maria R.
; Carvalho, Carlos Roberto R.
; Buchpiguel, Carlos A.
; Latronico, Ana Claudia
; Seelaender, Marilia
; Silva, Clovis Artur
; Pereira, Maria Fernanda B.
; Sallum, Adriana M. E.
; Brentani, Alexandra V. M.
; Neto, Álvaro José S.
; Ihara, Amanda
; Santos, Andrea R.
; Canton, Ana Pinheiro M.
; Watanabe, Andreia
; Santos, Angélica C. dos
; Pastorino, Antonio C.
; Franco, Bernadette D. G. M.
; Caruzo, Bruna
; Ceneviva, Carina
; Martins, Carolina C. M. F.
; Prado, Danilo
; Abellan, Deipara M.
; Benatti, Fabiana B.
; Smaria, Fabiana
; Gonçalves, Fernanda T.
; Penteado, Fernando D.
; Castro, Gabriela S. F. de
; Gonçalves, Guilherme S.
; Roschel, Hamilton
; Disi, Ilana R.
; Marques, Isabela G.
; Castro, Inar A.
; Buscatti, Izabel M.
; Faiad, Jaline Z.
; Fiamoncini, Jarlei
; Rodrigues, Joaquim C.
; Carneiro, Jorge D. A.
; Paz, Jose A.
; Ferreira, Juliana C.
; Ferreira, Juliana C. O.
; Silva, Katia R.
; Bastos, Karina L. M.
; Kozu, Katia
; Cristofani, Lilian M.
; Souza, Lucas V. B.
; Campos, Lucia M. A.
; Silva Filho, Luiz Vicente R. F.
; Sapienza, Marcelo T.
; Lima, Marcos S.
; Garanito, Marlene P.
; Santos, Márcia F. A.
; Dorna, Mayra B.
; Aikawa, Nadia E.
; Litvinov, Nadia
; Sakita, Neusa K.
; Gaiolla, Paula V. V.
; Pasqualucci, Paula
; Toma, Ricardo K.
; Correa-Silva, Simone
; Sieczkowska, Sofia M.
; Imamura, Marta
; Forsait, Silvana
; Santos, Vera A.
; Zheng, Yingying
.
OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
5.
Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
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Marques, Heloisa Helena de Sousa
; Pereira, Maria Fernanda Badue
; Santos, Angélica Carreira dos
; Fink, Thais Toledo
; Paula, Camila Sanson Yoshino de
; Litvinov, Nadia
; Schvartsman, Claudio
; Delgado, Artur Figueiredo
; Gibelli, Maria Augusta Bento Cicaroni
; Carvalho, Werther Brunow de
; Odone Filho, Vicente
; Tannuri, Uenis
; Carneiro-Sampaio, Magda
; Grisi, Sandra
; Duarte, Alberto José da Silva
; Antonangelo, Leila
; Francisco, Rossana Pucineli Vieira
; Okay, Thelma Suely
; Batisttella, Linamara Rizzo
; Carvalho, Carlos Roberto Ribeiro de
; Brentani, Alexandra Valéria Maria
; Silva, Clovis Artur
; Eisencraft, Adriana Pasmanik
; Rossi Junior, Alfio
; Fante, Alice Lima
; Cora, Aline Pivetta
; Reis, Amelia Gorete A. de Costa
; Ferrer, Ana Paula Scoleze
; Andrade, Anarella Penha Meirelles de
; Watanabe, Andreia
; Gonçalves, Angelina Maria Freire
; Waetge, Aurora Rosaria Pagliara
; Silva, Camila Altenfelder
; Ceneviva, Carina
; Lazari, Carolina dos Santos
; Abellan, Deipara Monteiro
; Santos, Emilly Henrique dos
; Sabino, Ester Cerdeira
; Bianchini, Fabíola Roberta Marim
; Alcantara, Flávio Ferraz de Paes
; Ramos, Gabriel Frizzo
; Leal, Gabriela Nunes
; Rodriguez, Isadora Souza
; Pinho, João Renato Rebello
; Carneiro, Jorge David Avaizoglou
; Paz, Jose Albino
; Ferreira, Juliana Carvalho
; Ferranti, Juliana Ferreira
; Ferreira, Juliana de Oliveira Achili
; Framil, Juliana Valéria de Souza
; Silva, Katia Regina da
; Kanunfre, Kelly Aparecida
; Bastos, Karina Lucio de Medeiros
; Galleti, Karine Vusberg
; Cristofani, Lilian Maria
; Suzuki, Lisa
; Campos, Lucia Maria Arruda
; Perondi, Maria Beatriz de Moliterno
; Diniz, Maria de Fatima Rodrigues
; Fonseca, Maria Fernanda Mota
; Cordon, Mariana Nutti de Almeida
; Pissolato, Mariana
; Peres, Marina Silva
; Garanito, Marlene Pereira
; Imamura, Marta
; Dorna, Mayra de Barros
; Luglio, Michele
; Rocha, Mussya Cisotto
; Aikawa, Nadia Emi
; Degaspare, Natalia Viu
; Sakita, Neusa Keico
; Udsen, Nicole Lee
; Scudeller, Paula Gobi
; Gaiolla, Paula Vieira de Vincenzi
; Severini, Rafael da Silva Giannasi
; Rodrigues, Regina Maria
; Toma, Ricardo Katsuya
; Paula, Ricardo Iunis Citrangulo de
; Palmeira, Patricia
; Forsait, Silvana
; Farhat, Sylvia Costa Lima
; Sakano, Tânia Miyuki Shimoda
; Koch, Vera Hermina Kalika
; Cobello Junior, Vilson
.
OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
6.
Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome
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Pereira, Maria Fernanda Badue
; Litvinov, Nadia
; Farhat, Sylvia Costa Lima
; Eisencraft, Adriana Pasmanik
; Gibelli, Maria Augusta Bento Cicaroni
; Carvalho, Werther Brunow de
; Fernandes, Vinicius Rodrigues
; Fink, Thais de Toledo
; Framil, Juliana Valéria de Souza
; Galleti, Karine Vusberg
; Fante, Alice Lima
; Fonseca, Maria Fernanda Mota
; Watanabe, Andreia
; Paula, Camila Sanson Yoshino de
; Palandri, Giovanna Gavros
; Leal, Gabriela Nunes
; Diniz, Maria de Fatima Rodrigues
; Pinho, João Renato Rebello
; Silva, Clovis Artur
; Marques, Heloisa Helena de Sousa
; Rossi Junior, Alfio
; Delgado, Artur Figueiredo
; Andrade, Anarella Penha Meirelles de
; Schvartsman, Claudio
; Sabino, Ester Cerdeira
; Rocha, Mussya Cisotto
; Kanunfre, Kelly Aparecida
; Okay, Thelma Suely
; Carneiro-Sampaio, Magda Maria Sales
; Jorge, Patricia Palmeira Daenekas
.
OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.
https://doi.org/10.6061/clinics/2020/e2209
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7.
Prospective cohort analyzing risk factors for chronic kidney disease progression in children,
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Belangero, Vera M.S.
; Prates, Liliane C.
; Watanabe, Andreia
; Schvartsman, Benita S.G.
; Nussenzveig, Paula
; Cruz, Natalia A.
; Abreu, Ana L.S.
; Paz, Isabel P.
; Facincani, Inalda
; Morgantetti, Fernanda E.C.
; Silva, Andreia O.
; Andrade, Olberes V.B.
; Camargo, Maria F.C.
; Nogueira, Paulo C. Koch
.
Resumo Objetivo: Identificar os fatores de risco para progressão da DRC em crianças do Brasil e avaliar as interações entre os fatores. Métodos: Coorte prospectiva multicêntrica em São Paulo, envolvendo 209 crianças com DRC em estágios 3-4. O desfecho do estudo incluiu: a) óbito, b) início da terapia de substituição renal, c) redução de > 50% na taxa estimada de filtração glomerular (eGFR) durante o acompanhamento. Foram testados 13 fatores de risco com o modelo de regressão univariada seguido do modelo de regressão multivariado de Cox. Os termos de interação entre as variáveis mostraram associação significativa e foram introduzidos ao modelo. Resultados: Após média de acompanhamento de 2,5 anos (IIQ = 1,4 a 3,0), 44 casos (21%) apresentaram desfecho: 22 iniciaram diálise, 12 apresentaram redução de > 50% na eGFR, sete foram submetidos a transplante e três morreram. Estágio avançado de DRC no acometimento (RR = 2,16, IC = 1,14-4,09), proteinúria nefrótica (RR = 2,89, IC = 1,49-5,62), idade (RR - 1,10, IC = 1,01-1,17), escore Z da pressão arterial sistólica (RR = 1,36, IC = 1,08-1,70) e anemia (RR = 2,60, IC - 1,41-4,77) foram associados ao resultado. Foi detectada interação entre anemia e proteinúria nefrótica na primeira visita (V1) (RR = 0,25, IC = 0,06-1,00). Conclusões: Como a primeira coorte de DRC no hemisfério sul, este estudo é concordante com os principais fatores relatados em países desenvolvidos com relação à progressão da DRC, afirmando o possível papel dos tratamentos para mostrar a evolução da DRC. A interação detectada sugere que a anemia pode ser mais nociva na progressão da DRC em pacientes sem proteinúria e deve ser ainda mais estudada.
Abstract Objective: To identify risk factors for chronic kidney disease progression in Brazilian children and to evaluate the interactions between factors. Methods: This was a multicenter prospective cohort in São Paulo, involving 209 children with CKD stages 3-4. The study outcome included: (a) death, (b) start of kidney replacement therapy, (c) eGFR decrease >50% during the followup. Thirteen risk factors were tested using univariate regression models, followed by multivariable Cox regression models. The terms of interaction between the variables showing significant association with the outcome were then introduced to the model. Results: After a median follow-up of 2.5 years (IQR = 1.4-3.0), the outcome occurred in 44 cases (21%): 22 started dialysis, 12 had >50% eGFR decrease, seven underwent transplantation, and three died. Advanced CKD stage at onset (HR = 2.16, CI = 1.14-4.09), nephrotic proteinuria (HR = 2.89, CI = 1.49-5.62), age (HR = 1.10, CI = 1.01-1.17), systolic blood pressure Z score (HR = 1.36, CI = 1.08-1.70), and anemia (HR = 2.60, CI = 1.41-4.77) were associated with the outcome. An interaction between anemia and nephrotic proteinuria at V1 (HR = 0.25, CI = 0.06-1.00) was detected. Conclusions: As the first CKD cohort in the southern hemisphere, this study supports the main factors reported in developed countries with regards to CKD progression, affirming the potential role of treatments to slow CKD evolution. The detected interaction suggests that anemia may be more deleterious for CKD progression in patients without proteinuria and should be further studied.
https://doi.org/10.1016/j.jped.2017.07.015
1352 downloads
8.
Current management issues of immediate postoperative care in pediatric kidney transplantation
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The number of pediatric kidney transplants has been increasing in many centers worldwide, as the procedure provides long-lasting and favorable outcomes; however, few papers have addressed the immediate postoperative care of this unique population. Herein, we describe the management of these patients in the early postoperative phase. After the surgical procedure, children should ideally be managed in a pediatric intensive care unit, and special attention should be given to fluid balance, electrolyte disturbances and blood pressure control. Antibiotic and antiviral prophylaxes are usually performed and are based on the recipient and donor characteristics. Thrombotic prophylaxis is recommended for children at high risk for thrombosis, although consensus on the optimum therapy is lacking. Image exams are essential for good graft control, and Doppler ultrasound must be routinely performed on the first operative day and promptly repeated if there is any suspicion of kidney dysfunction. Abdominal drains can be helpful for surveillance in patients with increased risk of surgical complications, such as urinary fistula or bleeding, but are not routinely required. The immunosuppressive regimen starts before or at the time of kidney transplantation and is usually based on induction with monoclonal or polyclonal antibodies, depending on the immunological risk, and maintenance with a calcineurin inhibitor (tacrolimus or ciclosporin), an anti-proliferative agent (mycophenolate or azathioprine) and steroids.
https://doi.org/10.6061/clinics/2014(Sup01)07
3198 downloads
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