Hypercalcemia (HC) has been variably reported in kidney transplanted (KTx) recipients (5–15%). Calcium levels peak around the 3rd month after KTx and thereafter slightly reduce and stabilize. Though many factors have been claimed to induce HC after KTx, the persistence of posttransplant hyperparathyroidism (PT-HPT) of moderate-severe degree is universally considered the first causal factor. Though not proven, there are experimental and clinical suggestions that HC can adversely affect either the graft (nephrocalcinosis) and other organs or systems (vascular calcifications, erythrocytosis, pancreatitis, etc.). However, there is no conclusive evidence that correction of serum calcium levels might avoid the occurrence of these claimed clinical effects of HC. The best way to reduce the occurrence of HC after KTx is to treat as best we can the secondary hyperparathyroidism (SHP) during the uraemic stages. The indication to Parathyroidectomy (PTX), either before or after KTx, in order to prevent or to treat, respectively, HC after KTx, is still a matter of debate which has been revived by the availability of the calcimimetic cinacalcet for the treatment of PT-HPT. However, we still need to better clarify many points as regards the potential adverse effects related to either PTX or cinacalcet use in this clinical set, and we are waiting for the results of future randomized controlled trials to achieve some more definite conclusions on this topic.
In this observational study atazanavir and lopinavir showed similar safety and activity in pregnancy, with no differences in the main pregnancy outcomes. Atazanavir use was associated with a better lipid profile and with higher bilirubin levels. Overall, the study findings confirm that these two HIV protease inhibitors represent equally valid alternative options.
Objective: To verify the efficacy of oral iodide therapy in treating a case of early neonatal hyperthyroidism due to maternal Graves’ disease. Methods: We report a case of neonatal hyperthyroidism which occurred in a 2,650-gram, female baby, born at 39 weeks’ gestational age (GA) to a 30-year-old mother affected by Graves’ disease and treated with thionamides (propylthiouracil) from the 20th week of gestation. A fetal goiter, due to maternal therapy, had been observed by ultrasound scan at 31 and 35 weeks of gestation, with contemporary low cord thyroid hormone levels. Two intra-amniotic injections of levothyroxine were then performed at 34 and 36 weeks of gestation, which led to a significant reduction of fetal goiter and to normalization of cord thyroid hormone levels. The neonatal clinical course was characterized by symptoms of hyperthyroidism from the 2nd to 3rd days of life (irritability, tachycardia, tachypnea, hyperphagia), mostly during feeding. Oral treatment with potassium iodide (KI, 8 mg × 3 times a day) was started at 23 days of life. Results: Treatment with KI led to a significant reduction of neonatal clinical symptoms and to a normalization of hormone levels within 4 days of therapy. The treatment was discontinued in 13th week of life because of neonatal well-being and normal hormone levels. Conclusions: We believe that KI therapy is effective in treating neonatal hyperthyroidism and does not cause suppression of neonatal thyroid activity, which is possible using antithyroid drugs like thionamides.
R-Hu-EPO treatment in first post-natal weeks markedly enhanced erythropoiesis in severely premature infants compared with matched controls, with a significant impact on transfusion needs. EPO group experienced also a reduction of ventilation time and, possibly, a decreased occurrence of clinical BPD.
Abbreviations aPTT partial thromboplastin time á BW birth weight á GA gestational age á INR international normalized ratio á IVH intraventricular haemorrhage á PDA patent ductus arteriosus á PIE pulmonary interstitial emphysema á PH pulmonary haemorrhage á SGA small for gestational age Sir: Few studies have been conducted on pulmonary haemorrhage (PH) in premature infants and recently an increased incidence has been ascribed to surfactant use [5]. During two multicentre trials on the use of a natural surfactant preparation (Curosurf) [1, 2], we evaluated the frequency of PH and investigated prospectively the factors involved on its development in 97 neonates with gestational age (GA) <30 weeks. Forty neonates were randomly assigned to receive surfactant at birth: 22 neonates (GA = 28.3 0.8 weeks; birth weight (BW) = 934 299 g) received surfactant, 18 (GA = 27.8 1.6 weeks; BW = 908 215 g) air placebo [1]. Fifty-seven neonates (GA = 27.6 1.8 weeks; BW = 940 350 g) received Curosurf (200 mg/kg) as rescue therapy within the ®rst 24 h of life. PH was diagnosed when bright red blood was present in the endotracheal tube, in association with clinical deterioration and the appearance of new densities on the chest radiograph during the ®rst 3 days of life. A maximum of 3 days was selected to limit evaluation of eects of surfactant administration. During this period we reported clinical evidence of haemorrhage at sites other than lung as well as the presence of pulmonary interstitial emphysema (PIE), patent ductus arteriosus (PDA), intraventricular haemorrhage (IVH) and sepsis. Platelet count and coagulation tests (aPTT, INR and ®brinogen level) were carried out in all neonates, as soon as possible after birth and always within the ®rst 12 h of life. Statistical evaluation was made by Student's t-test and chi-squared test, using the Yates correction when necessary. Stepwise logistic regression analysis to assess the independent eect of a particular variable on the presence of PH was carried out.No statistically signi®cant dierence in the incidence of PH was found among the three groups: 18% (4/22) in the prophylactic group, 11% (2/18) in the control group and 11% (6/57) in the rescue group. PH occurred always between 24 and 72 h after birth and was the most frequent cause of death in the ®rst 72 h of life. Of the neonates with PH, (8/10) 80% died of severe pulmonary bleeding.To evaluate possible causes of PH other than surfactant administration we compared clinical and laboratory data of 10
Streptococcus pneumoniae sepsis has high morbidity, particularly if complicated by renal injury. Four patients with S. pneumonia invasive infections complicated by renal disorders are presented. The first case was an 18-month-old girl with pneumococcal empyema complicated by haemolytic uraemic (HUS) syndrome. She made a full recovery after mechanical ventilation, inotropic support and haemodiafiltration. The second was a 4-year-old boy who presented with acute post-infectious glomerulonephritis associated with bilateral pneumococcal pneumonia. He too made a complete recovery. The third was a newborn girl with pneumococcal meningitis complicated by acute respiratory distress syndrome and acute renal failure. The fourth patient was an 8-month-old boy with pneumococcal pneumonia and meningitis complicated by HUS and with fulminant thrombotic thrombocytopenic purpura. Despite full support including mechanical ventilation and haemodiafiltration, he died 4 days after admission. On follow-up, all three survivors recovered completely from their pulmonary symptoms and had normal renal function and cardio-circulatory status in the mid-term.
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