One hundred and fifty teeth from 15 cats of an average age of 6.8 years were examined macroscopically, radiographically, and histologically. Clinical inspection revealed plaque and calculus deposits on the facial surfaces of maxillary and mandibular premolars and molars. Radiography showed horizontal and vertical loss of alveolar bone with irregular defects of the dental hard structures. Histologically, typical features of gingival and periodontal destruction were found and resorptive lacunae were seen at the cemento‐enamel junctions. In comparison with experimentally induced periodontitis in other animals, periodontal disease involving external root resorption seemed to occur spontaneously in the cat.
Introduction. Retrospective observational data show that ACE-inhibitor therapy delays renal failure and improves life expectancy in Alport patients with proteinuria. The EARLY PRO-TECT Alport trial assesses the safety and efficacy of early therapy onset with ramipril in pediatric Alport patients. Methods and analysis. This double-blind, randomized, placebo-controlled, multicenter phase III trial (NCT01485978; EudraCT-number 2010-024300-10) includes 120 pediatric patients aged 24 months to 18 years with early stages of Alport syndrome (isolated hematuria or microalbuminuria). From March 2012, up to 80 patients will be randomized 1:1 to ramipril or placebo. In the event of disease progression during 3-year treatment, patients are unblinded and ramipril is initiated, if applicable. Approximately 40 patients receive open-label ramipril contributing to the safety database. Primary end-points are “time to progression to next disease level” and “incidence of adverse drug events before disease progression.” Treatment effect estimates from the randomized comparison and Alport registry data will be combined in supportive analyses to maximize evidence. Conclusion. Without this trial, ACE inhibitors may become standard off-label treatment in Alport syndrome without satisfactory evidence base. The results are expected to be of relevance for therapy of all pediatric patients with kidney disease, and the trial protocol might serve as a model for other rare pediatric glomerulopathies.
In a prospective matched case-control study of sporadic pediatric hemolytic uremic syndrome related to Shiga-toxin producing Escherichia coli infection in France, eating undercooked ground beef, contact with a person with diarrhea, and drinking well water during the summer period were identified as risk factors. Prevention efforts in France should focus on reducing not only food-borne but also person-to-person transmission.
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