The literature on sero-epidemiological studies of flaviviral infections in the African continent is quite scarce. Much of the viral epidemiology studies have been focussing on diseases such as ...HIV/AIDS because of their sheer magnitude and impact on the lives of people in the various affected countries. Increasingly disease outbreaks caused by arboviruses such as the recent cases of chikungunya virus, dengue virus and yellow fever virus have prompted renewed interest in studying these viruses. International agencies from the US, several EU nations and China are starting to build collaborations to build capacity in many African countries together with established institutions to conduct these studies. The Tofo Advanced Study Week (TASW) was established to bring the best scientists from the world to the tiny seaside town of Praia do Tofo to rub shoulders with African virologists and discuss cutting-edge science and listen to the work of researchers in the field. In 2015 the 1st TASW focussed on Ebola virus. The collections of abstracts from participants at the 2nd TASW which focused on Dengue and Zika virus as well as presentations on other arboviruses are collated in this chapter.
To identify risk factors for chronic kidney disease progression in Brazilian children and to evaluate the interactions between factors.
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.
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.
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.
Identificar os fatores de risco para progressão da DRC em crianças do Brasil e avaliar as interações entre os fatores.
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.
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).
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.
Introduction We evaluated the applicability of laparoscopic nephrectomy in the treatment of multicystic dysplastic kidney (MCDK) in children, including procedures performed by resident physicians or ...trainees in surgical urology. Methods We retrospectively evaluated the medical records of 20 children with MCDK who underwent laparoscopic nephrectomy over a six-year period. Data collected included gender, laterality of the affected kidney, age at the time of surgery, the largest diameter of the multicystic kidney and associated urological diagnoses, surgical, and postoperative data. All surgical procedures were performed transperitoneally. Results The mean age at the time of surgery was 46 months with a slight predominance of girls. The right side was the more affected side, and the average diameter of the affected kidney at the time of surgical excision was 5.8 cm. Other changes in the urinary tract were found in five children. The mean operative time was 133 minutes. On pathological examination, on average, the pieces measured 4.8 cm and weighed 18.1 g. There were no operative complications. The average length of hospital stay was 37.35 hours. Conclusion Laparoscopic nephrectomy was confirmed as an applicable treatment for MCDK. The technique was easy to perform, safe and efficient, even when performed by trainees in pediatric urology.
The pathophysiology of hepatic osteodystrophy (HO) remains poorly understood. Our aim was to evaluate bone histomorphometry, biomechanical properties, and the role of the growth hormone ...(GH)/insulin-like growth factor-I (IGF-I) system in the onset of this disorder. Forty-six male Wistar rats were divided into two groups: sham-operated (SO,
n
= 23) and bile duct–ligated (BDL,
n
= 23). Rats were killed on day 30 postoperatively. Immunohistochemical expression of IGF-I and GH receptor was determined in liver tissue and in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia, and the right femur was used for biomechanical analysis. The maximal force at fracture and the stiffness of the mid-shaft femur were, respectively, 53% and 24% lower in BDL compared to SO. Histomorphometric measurements showed low cancellous bone volume and decreased cancellous bone connectivity in BDL, compatible with osteoporosis. This group also showed increased mineralization lag time, indicating disturbance in bone mineralization. Serum levels of IGF-I were lower in BDL (basal 1,816 ± 336 vs. 30 days 1,062 ± 191 ng/ml,
P
< 0.0001). BDL also showed higher IGF-I expression in the liver tissue but lower IGF-I and GH receptor expression in growth plate cartilage than SO. Osteoporosis is the most important feature of HO; BDL rats show striking signs of reduced bone volume and decreased bone strength, as early as after 1 month of cholestasis. The endocrine and autocrine–paracrine IGF-I systems are deeply affected by cholestasis. Further studies will be necessary to establish their role in the pathogenesis of HO.
PDF
