Neonates with Bartter syndrome have enormous fluid and sodium requirements.

AIM: Managing neonatal Bartter syndrome by achieving adequate weight gain is challenging. We assessed the correlation between weight gain in neonatal Bartter syndrome and the introduction of fluid and sodium supplementations and indomethacin during the first 4 weeks of life. METHODS: Daily fluid and electrolytes requirements were analysed using linear regression and Spearman correlation coefficients. The weight gain coefficient was calculated as daily weight gain after physiological neonatal weight loss. RESULTS: We studied seven infants. The highest weight gain coefficients occurred between weeks two and four in the five neonates who either received prompt amounts of fluid (maximum 810 mL/kg/day) and sodium (maximum 70 mmol/kg/day) or were treated with indomethacin. For the two patients with the highest weight gain coefficient, water and sodium supplementations were decreased in weeks two to four leading to a significant negative Spearman correlation between weight gain and fluid supplements (r = -0.55 and -0.68) and weight gain and sodium supplementations (r = -0.96 and -0.72). The two patients with the lowest weight gain coefficient had positive Spearman correlation coefficients between weight gain and fluid and sodium supplementations. CONCLUSION: Infants with neonatal Bartter syndrome required rapid and enormous fluid and sodium supplementations or the early introduction of indomethacin treatment to achieve adequate weight gain during the early postnatal period.

Is there an age cutoff to apply adult formulas for GFR estimation in children?

BACKGROUND: Estimation of glomerular filtration rate (eGFR) using a common formula for both adult and pediatric populations is challenging. Using inulin clearances (iGFRs), this study aims to investigate the existence of a precise age cutoff beyond which the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), or the Cockroft-Gault (CG) formulas, can be applied with acceptable precision. Performance of the new Schwartz formula according to age is also evaluated. METHOD: We compared 503 iGFRs for 503 children aged between 33 months and 18 years to eGFRs. To define the most precise age cutoff value for each formula, a circular binary segmentation method analyzing the formulas' bias values according to the children's ages was performed. Bias was defined by the difference between iGFRs and eGFRs. To validate the identified cutoff, 30% accuracy was calculated. RESULTS: For MDRD, CKD-EPI and CG, the best age cutoff was ≥14.3, ≥14.2 and ≤10.8 years, respectively. The lowest mean bias and highest accuracy were -17.11 and 64.7% for MDRD, 27.4 and 51% for CKD-EPI, and 8.31 and 77.2% for CG. The Schwartz formula showed the best performance below the age of 10.9 years. CONCLUSION: For the MDRD and CKD-EPI formulas, the mean bias values decreased with increasing child age and these formulas were more accurate beyond an age cutoff of 14.3 and 14.2 years, respectively. For the CG and Schwartz formulas, the lowest mean bias values and the best accuracies were below an age cutoff of 10.8 and 10.9 years, respectively. Nevertheless, the accuracies of the formulas were still below the National Kidney Foundation Kidney Disease Outcomes Quality Initiative target to be validated in these age groups and, therefore, none of these formulas can be used to estimate GFR in children and adolescent populations.

Medicina árabe en la época medieval: nuevos datos biográficos y contribuciones, con especial referencia al Califato de Córdoba / Arabian medicine in the Middle Ages: new biographic data and contributions specially related to cordovan caliphate

La presente comunicación completa la primera sobre la "Medicina Arabe Medieval" (Revista Cubana de Pediátria, 47: 1, pág. 103, 1975). Ambas están dedicadas a destacar lo que la medicina y la cirugía modernas deben a los árabes, y la influencia de los mismos en las universidades de Occidente mediante sus obras, manuscritos, etc., escritos en idioma árabe, la lengua culta de la "Edad Media". Esta civilización se extendió desde España hasta el oeste de la India, conmovio al mundo y abrió durante siete siglos una era de esplendor y progreso para la humanidad(AU)

La reacción de Weltmann en asma, bronconeumonías y neumonías lobares en niños / Welmann reaction in asthma, bronchopneumonias and lobar pneumonies in children

Se presentaron los resultados de la reacción de Weltmann y la técnica empleada en 40 pacientes asmáticos, 23 asmáticos complicados, 56 pacientes con bronconeumonías y 42 con neumonías lobares. En asmaticos aparentemente libres de infección, la reacción fue normal en el 90 por ciento de ellos. En cambio, cuando se estudió en 10 asmático con bronconeumonías, la reacción se encontró desviada hacia la izquierda en el 100 por ciento. El Weltamann fue de gran utilidad para orientarnos frente a asmáticos con radiografías pulmonares sugestivas de procesos inflamatorios añadidos, siendo normal en el 90 por ciento de los pacientes con atelectacsias, mientras que en asmáticos con bronconeumonías la reacción se encontró desviada hacia la izquierda en la totalidad de ellos. La reacción se presentó inicialmente acortada en el 82 por ciento de las bronconeumonías y en el 90 por ciento de las neumonías lobares, siendo también de utilidad para seguir la evolución favorable del proceso, aunque no encontramos relación entre la extensión del mismo y el grado de desviación hacia la izquierda excepto cuando se añadia pleuresía purulenta en que siempre se encontró una reacción de 0. Consideramos que la reacción parece aún de utilidad para orientarnos en afecciones broncopulmonares en niños(AU)