|Year : 2020 | Volume
| Issue : 2 | Page : 41-42
Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||15-Dec-2020|
|Date of Decision||15-Dec-2020|
|Date of Acceptance||15-Dec-2020|
|Date of Web Publication||31-Dec-2020|
Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bagga A. ‘Highlights’. Asian J Pediatr Nephrol 2020;3:41-2
Greetings from New Delhi. We end the third year of publication of the Journal, with mixed feelings. The year has seen an unprecedented crisis in form of the COVID-19 pandemic that has been associated with high morbidity and mortality. The pandemic has affected economies and livelihoods, strained medical resources and health care, and significantly impacted medical education and training. On the other hand, the pandemic resulted in large investments in health infrastructure, research into novel therapies for the disease, and worldwide escalation of efforts for developing vaccines that is already yielding positive results!
Physical meetings have been replaced by online conferences and webinars and hospital visits by teleconsultations. There have been a large number of publications related to COVID-19, as well as modest increase in the number of submissions for non-COVID diseases. The number of manuscripts submitted to the Journal has increased by one-third this year.
This issue of the Journal features a systematic review on the prevalence of Shiga toxin-producing organisms in food and animal products, a randomized controlled study on steroid-sensitive nephrotic syndrome, and a prospective report on etiology and outcomes in neonatal acute kidney injury (AKI).
Shiga toxin-producing Escherichia coli (STEC) infections are a significant health problem across the world.
These infections, transmitted through contaminated food and drinking water, are an important cause of hemorrhagic colitis and hemolytic uremic syndrome. The systematic review from Iran by Hooman et al. includes the data from 58 studies on the food and animal sources of STEC published between 1985 and 2018. The authors report a pooled prevalence of 5.7% in food studies and 10.2% in animal studies, suggesting significant contamination. Dairy products showed higher contamination compared to meat or vegetables, and the chief serotypes detected were O157 and O26. These reports are important since they underscore the importance of the modes of transmission of STEC. Outbreaks of hemorrhagic colitis associated with STEC have been reported following ingestion of contaminated beef, lamb, small ruminant meat, poultry, dairy products, fruit juices and green vegetables, and drinking water. Direct animal-to-person transmission is also reported. Following the German outbreak in 2011, several developed countries have collaborated to implement surveillance protocols for the early detection and reporting of STEC infections. However, data from Asia have been limited to a few countries in the Western Pacific region. Collation of such information will help in developing strategies, equipping laboratories, and ensuring active surveillance to lower the global burden of STEC infections and its consequences.
The management of patients with frequently relapsing and steroid-dependent nephrotic syndrome is challenging. A number of steroid-sparing therapies have been utilized to reduce the frequency of relapses and prevent side effects associated with long-term corticosteroid use. This issue reports the results of an open-labeled randomized controlled trial in 42 patients with frequently relapsing or steroid-dependent nephrotic syndrome, comparing therapies with levamisole (2.5 mg/kg) or mycophenolate mofetil (MMF, 850–1100 mg/sq. m), both administered daily, for a duration of 12 months. Relapse frequency reduced by 65% in levamisole treated patients, compared to 56% receiving MMF (mean difference 9.1%; 95% confidence interval: -16.9, 35.2). Both agents had similar steroid sparing effect, and therapy with prednisolone could be discontinued in 8 and 6 patients, respectively. The authors conclude that in patients with relapsing steroid-sensitive nephrotic syndrome, daily therapy with levamisole was not-inferior to MMF. These findings support the results of a recently published study that did not find significant differences in the efficacy of alternate-day levamisole compared to MMF. Data from recent studies highlight the use of alternate-day levamisole as an effective and inexpensive steroid-sparing agent, with better results in frequent relapsers compared to steroid dependence.
The findings of the above study, that specifically examined the use of daily levamisole, should be viewed with caution given the size of the study and few baseline differences between the two arms. The low rates of adverse events and infections, compared to other studies using these agents, might perhaps reflect infrequent monitoring or less rigorous recording of such events. Randomized placebo-controlled trials powered to detect differences in adverse effects (including monitoring for antineutrophil cytoplasmic antibodies, small vessel vasculitis, raised transaminases, and neutropenia) are necessary to compare the safety and efficacy of daily versus alternate-day levamisole, before considering a change in the frequency of its administration.
Research based on single-center cohorts suggest that neonatal AKI is common and associated with poor outcomes. Mitharwal et al. report the results of a 12-month prospective study on AKI in critically-ill neonates admitted to a tertiary care center in Rajasthan. Of 3422 neonates, 983 (28.7%) had AKI; the stage was risk in 58%, failure in 25%, and injury in 17% neonates. The factors associated with AKI included dehydration related to high ambient temperatures, sepsis, perinatal asphyxia, and respiratory distress. Neonates with AKI were at higher risk of mortality, being highest in those with failure. These findings mirror those reported in the multicenter international retrospective observational cohort, Assessment of Worldwide AKI Epidemiology in Neonates, which reported the occurrence of AKI in 21% of 2110 neonates admitted to 24 neonatal intensive care unit (NICU). Patients with AKI had a 7-day longer duration of NICU stay and 2.8 fold risk of mortality. The risk factors for the occurrence of AKI included outborn deliveries, resuscitation with epinephrine, admission diagnosis of hyperbilirubinemia or inborn errors of metabolism, and the need for surgery. The presence of these risk factors could well serve as “red flags” for clinicians. The role of biochemical or physiological biomarkers in neonatal AKI needs closer examination.
The current issue also features a selection of virtually presented free papers at the Annual Conference of the Indian Society of Pediatric Nephrology. We will be happy to publish the selected abstracts of other national meetings as well. We continue to look forward to your scholarly submissions that will go a long-way in increasing the readership and impact of this Journal.
Best wishes for a healthy New Year.
| References|| |
Hooman N, Khodadost M, Bitzan M, Ahmadi A, Nakhaie S, Naghshizadian R. Reservoirs of infection with Shiga toxin producing Escherichia coli
in Iran: Systematic review. Asian J Pediatr Nephrol 2020;3:49-57. [Full text]
Pires SM, Majowicz S, Gill A, Devleesschauwer B. Global and regional source attribution of Shiga toxin-producing Escherichia coli
infections using analysis of outbreak surveillance data. Epidemiol Infect 2019;147:e236.
Singh J, Afzal K, Abqari S. Daily levamisole versus mycophenolate mofetil in patients with frequently relapsing or steroiddependent nephrotic syndrome: An openlabel noninferiority randomized controlled trial. Asian J Pediatr Nephrol 2020;3:43-8. [Full text]
Sinha A, Puraswani M, Kalaivani M, Goyal P, Hari P, Bagga A. Efficacy and safety of mycophenolate mofetil versus levamisole in frequently relapsing nephrotic syndrome: An openlabel randomized controlled trial. Kidney Int 2019;95:210-8.
Gruppen MP, Bouts AH, Jansen-van der Weide MC, Merkus MP, Zurowska A, Maternik M, et al
. A randomized clinical trial indicates that levamisole increases the time to relapse in children with steroidsensitive idiopathic nephrotic syndrome. Kidney Int 2018;93:510-8.
Mitharwal R, Makwana M, Mourya HK, Kumari S, Shivji Ram S. A prospective study of acute kidney injury in outborn neonates admitted in a tertiary care centre in western Rajasthan. Asian J Pediatr Nephrol 2020;5:58-63.
Charlton JR, Boohaker L, Askenazi D, Brophy PD, D'Angio C, Fuloria M, et al
. Incidence and risk factors of early onset neonatal AKI. Clin J Am Soc Nephrol 2019;14:184-95.