Idiopathic nephrotic syndrome is the most frequent pediatric glomerular disease, affecting from 1.15 to 16.9 per 100,000 children per year globally. It is characterized by massive proteinuria, hypoalbuminemia, and/or concomitant edema. Approximately 85–90% of patients attain complete remission of proteinuria within 4–6 weeks of treatment with glucocorticoids, and therefore, have steroid-sensitive nephrotic syndrome (SSNS). Among those patients who are steroid sensitive, 70–80% will have at least one relapse during follow-up, and up to 50% of these patients will experience frequent relapses or become dependent on glucocorticoids to maintain remission. The dose and duration of steroid treatment to prolong time between relapses remains a subject of much debate, and patients continue to experience a high prevalence of steroid-related morbidity. Various steroid-sparing immunosuppressive drugs have been used in clinical practice; however, there is marked practice variation in the selection of these drugs and timing of their introduction during the course of the disease. Therefore, international evidence-based clinical practice recommendations (CPRs) are needed to guide clinical practice and reduce practice variation. The International Pediatric Nephrology Association (IPNA) convened a team of experts including pediatric nephrologists, an adult nephrologist, and a patient representative to develop comprehensive CPRs on the diagnosis and management of SSNS in children. After performing a systematic literature review on 12 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, recommendations were formulated and formally graded at several virtual consensus meetings. New definitions for treatment outcomes to help guide change of therapy and recommendations for important research questions are given.
Objetivo. Analizar la tendencia de las tasas de incidencia, mortalidad y supervivencia al cáncer de próstata (CP) en el periodo 1962-2011. Material y métodos. Con base en el Registro Poblacional de Cáncer en Cali (Colombia) y los registros de mortalidad de la Secretaría de Salud Pública Municipal se analizaron las tendencias de las tasas de incidencia, mortalidad y supervivencia por CP en Cali durante el periodo 1962-2011. Resultados. La incidencia de cáncer de próstata aumentó vertiginosamente entre 1986 y 2002 (Annual Percent Change APC 6.2%) y se estabilizó posteriormente. La mortalidad disminuyó desde 1997 en los mayores de 70 años, mientras que en el grupo de 50-69 años fue a partir de 1981. La supervivencia relativa a cinco años fue 69.8% (IC95% 67.5-72.0) y se asoció de manera significativa con la edad, periodo de diagnóstico y estrato socioeconómico. Conclusión. El incremento en la incidencia del CP coincide temporalmente con la implementación del antígeno específico de próstata (PSA por sus siglas en inglés) en Cali; hay evidencia de mejoría en la supervivencia en el CP y disminución en su mortalidad.
We have examined the characteristics of the magnetic order present at room and lower temperatures in disordered samples corresponding to the Fe0.9−xMn0.1Alx (0.1⩽x⩽0.5) series prepared by arc melting, high temperature homogenization, and quenching. To that purpose we have measured the compositional variation of the lattice parameters, the Mössbauer spectra, the high field magnetization, and the saturation coercivity and also the compositional and temperature dependences of the magnetic susceptibility and the low field magnetization. Our results are summarized in a magnetic phase diagram including ferromagnetic, paramagnetic, pure spin glass, and reentrant spin glass regions.
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