The Pediatric Nephrology Standard of Care is essential for the diagnosis, monitoring, and management of children with Chronic Kidney Disease (CKD). Early detection of kidney changes is essential since many conditions can be silent, but have a major impact on the child's growth and development. The Standard of Care structure includes neonatal screening, assessment of predisposing conditions for kidney disease, calculation of the estimate of renal function and classification of the CKD stage to propose drug and nondrug therapeutic interventions. Challenges such as shortage of specialists, need for screenings and unequal access to services reinforce the importance of robust public policies and training programs. Personalized protocols are recommended to delay progression to Renal Replacement Therapy. In September 2024, the Clinical Guidelines and Therapeutic Protocol (CGTP) for CKD in adults was launched. In this Opinion article, a group of Pediatric Nephrologists comment on the perspectives for creating a CGTP for children and adolescents with CKD.
Background: Patients with rheumatoid arthritis (RA) generally have elevated levels of rheumatoid factor (RF), which binds to the crystallizable fraction (Fc) of monoclonal antibodies, diminishing tumour necrosis factor inhibitor (TNFi) efficacy. We assessed clinical response to PEGylated, Fc-free certolizumab pegol (CZP) across baseline RF levels in Brazilian patients with RA. Methods: Reported patients (>6 months disease duration) received CZP (200 mg every 2 weeks [Q2W] or 400 mg Q4W) after failure or intolerance to conventional synthetic or biologic disease-modifying antirheumatic drugs. Data were collected from medical records before initiation, at 3 months and at 6 months of CZP. Patients were stratified by baseline RF quartiles. Disease activity was assessed by the Clinical Disease Activity Index (CDAI). Results: Amongst 51 patients, 49 (96.1%) were women, the mean age (standard deviation [SD]) was 49.8 (13.7) years and 23 (45.1%) were receiving methotrexate. RA duration (SD) was 17.0 (9.5) years. Of 43 patients with baseline RF values, mean RF (SD) was 224.3 (363.5) IU/mL. At baseline, 3 months and 6 months, CDAI for patients overall was 18.6 (10.4), 9.8 (8.6) and 12.5 (11.7); for those with baseline RF≤Q3 (n=34) versus >Q3 (n=9), CDAI was 18.4 (11.0) versus 20.0 (10.7), 9.2 (7.9) versus 8.4 (9.8) and 12.8 (13.2) versus 10.9 (8.9). CDAI remission/ low disease activity rates at baseline, 3 months and 6 months were 4.1%/18.4%, 23.4%/29.8% and 11.9%/40.5%; for those with baseline RF≤Q3 (n=34) versus >Q3 (n=9), CDAI remission/low disease activity rates were 2.9%/20.6% versus 11.1%/0.0% at baseline, 30.3%/24.2% versus 12.5%/50.0% at 3 months and 14.3%/42.9% versus 12.5%/37.5% at 6 months. Conclusion: Baseline RF values did not appear to influence CZP clinical response in this cohort of patients with RA. However, small sample size and data heterogeneity restricted generalizability. Efficacy data from larger cohorts may further elucidate the impact of high RF levels in patients receiving Fc-free biologics. Download the Plain Language Summary of this article: https://www.drugsincontext.com/plain-language-summaries/plain-language-summary-lack-of-association-between-rheumatoid-factor-levels-and-clinical-response-to-certolizumab-pegol-in-patients-with-rheumatoid-arthritis-an-observational-study
Objectives: Adenoid cystic carcinoma of the breast (CACM) is uncommon, comprising less than 0.1% of breast carcinomas. In the literature, many authors argue that local control is achieved through mastectomy, especially in high-grade histological tumors. We report a case of CACM treated with conservative surgery at the Mastology Service of Hospital das Clínicas da UFMG. Methods: ASG, a 62-year-old, female patient presented with a 2-cm palpable nodule on the left breast, with the following mammographic representation: isodense nodule in the upper lateral quadrant, obscured contours, measuring 20 mm. She underwent a diagnostic sectorectomy and was diagnosed with basaloid solid-type CACM, grade 3, triple-negative phenotype, measuring 1.5 cm, with compromised lateral and anterior margins. She underwent a new sectorectomy and sentinel lymph node biopsy, with no invasive neoplasm in the sample and four sentinel lymph nodes, all free of metastasis. Subsequently, she underwent radiotherapy. On biopsy, CACM, grade 2, triple-negative phenotype was diagnosed. She was treated with conservative surgery and radiotherapy. Results: Follow-up with no signs of local recurrence or distant metastasis at one-year follow-up. Conclusion: Although most adenoid cystic carcinomas present with the basal-like, triple-negative phenotype, these tumors are generally of low histological grade and present an indolent biological behavior. Based on these clinical characteristics, the most recent studies have demonstrated the effectiveness of treatment with a complete excision of the tumor with wide margins and the addition of radiotherapy.
Two Brazilian medical societies have proposed a new classification of obesity based on the maximum weight attained in an individual's lifetime, to be used in the clinical evaluation of individuals undergoing obesity treatment. This classification, which applies to adults aged 18 to 65 years, categorises people with obesity (PwO) who lose a certain percentage of their weight as having either 'reduced' or 'controlled' obesity. While the classification aims to improve patient care, there is limited data on PwO perceptions. To explore this, a cross-sectional online survey was conducted with 500 PwO, including an explanation and clinical case of the new classification. The survey revealed that 64% of participants had never been asked by a healthcare professional (HCP) about their maximum weight. After knowing the new classification, 82% found it useful for changing perceptions about obesity treatment; 66% felt it would encourage them to seek treatment; 63% believed it would help with treatment maintenance; and 74% indicated they would feel better achieving 'controlled obesity,' even if the weight loss fell short of their goals. A majority agreed that the classification could help establish realistic goals (77%) and reduce biases from HCPs (69%). Overall, PwO perceived the classification as beneficial for encouraging treatment and reducing stigma.
RESUMO A Linha de Cuidado em Nefrologia Pediátrica é essencial para o diagnóstico, acompanhamento e manejo de crianças com Doença Renal Crônica (DRC). A detecção precoce de alterações renais é fundamental, uma vez que muitas condições podem ser silenciosas, mas ter grande impacto no crescimento e desenvolvimento da criança. A estrutura da Linha de Cuidado inclui triagem neonatal, avaliação de condições predisponentes à doença renal, cálculo da estimativa da função renal e classificação do estágio da DRC, visando à programação de intervenções terapêuticas medicamentosas e não medicamentosas. Desafios como a escassez de especialistas, a necessidade de exames e o acesso desigual aos serviços reforçam a importância de políticas públicas robustas e programas de treinamento. Protocolos personalizados são recomendados para retardar a progressão para Terapia Renal Substitutiva (TRS). Em setembro de 2024, foi lançado o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) para DRC em adultos. Neste artigo de opinião, um grupo de nefrologistas pediátricos comenta as perspectivas para a criação de um PCDT para crianças e adolescentes com DRC.
