Defining steroid sensitivity represents a first critical aspect for prognosis, as forms that respond do not evolve toward chronic renal failure. In MCD, unlike other glomerular diseases, steroid response when present is often complete, with total disappearance of proteinuria. However, time to remission is very different in children compared with adults. As shown in Figure 2, after a first episode, approximately 50% of children achieve remission within 8 days of steroid treatment and most patients who are going to respond to steroids do so within 4 weeks. In contrast, in adults the median time to remission exceeds 2 months. In both populations, MCD has a high tendency to relapse, and relapses tend to be more rapid in children.
The world has changed dramatically in the three months since our last update of the World Economic Outlook in January. A rare disaster, a coronavirus pandemic, has resulted in a tragically large number of human lives being lost. As countries implement necessary quarantines and social distancing practices to contain the pandemic, the world has been put in a Great Lockdown. The magnitude and speed of collapse in activity that has followed is unlike anything experienced in our lifetimes.
Under the assumption that the pandemic and required containment peaks in the second quarter for most countries in the world, and recedes in the second half of this year, in the April World Economic Outlook we project global growth in 2020 to fall to -3 percent. This is a downgrade of 6.3 percentage points from January 2020, a major revision over a very short period. This makes the Great Lockdown the worst recession since the Great Depression, and far worse than the Global Financial Crisis.
Assuming the pandemic fades in the second half of 2020 and that policy actions taken around the world are effective in preventing widespread firm bankruptcies, extended job losses, and system-wide financial strains, we project global growth in 2021 to rebound to 5.8 percent.
Multilateral cooperation is vital to the health of the global recovery. To support needed spending in developing countries, bilateral creditors and international financial institutions should provide concessional financing, grants, and debt relief. The activation and establishment of swap lines between major central banks has helped ease shortages in international liquidity, and may need to be expanded to more economies. Collaborative effort is needed to ensure that the world does not de-globalize, so the recovery is not damaged by further losses to productivity.
It is logical that it may not take as long to complete active treatment in patients with small thrombi provoked by a factor that rapidly resolves. Consistent with this hypothesis, patients with isolated distal DVT provoked by a temporary risk factor, such as recent surgery, did not appear to have a higher risk of recurrence if treatment was stopped at 4 or 6 weeks compared with at 3 months or longer (hazard ratio, 0.36; 95% CI, 0.09-1.54).3 Although 4 or 6 weeks of anticoagulation may complete active treatment in patients with a small thrombus and a reversible provoking factor, this was not evident when only 1 of these 2 factors applied.3
Patients who are treated indefinitely should be reviewed regularly (eg, annually) to ensure that: (1) they have not developed contraindications to anticoagulant therapy; (2) their preferences have not changed; (3) they can avail of improved ways to predict risk of recurrence and the possibility of safely stopping therapy; and (4) they are being treated with the most suitable anticoagulant regimen.
In other parts of Europe, the detection of statistically robust trend is yet more challenging, as shown below for some capitals in Northwestern Europe. Weather-related episodes of high (between weeks 3 and 4; week 6) and low NO2 surface concentrations are the main features that can be seen.
More than 50% of patients present a healing at CT scan after 6 weeks, and subsequent image follow-up seems to have no clinical utility [24, 135]. Complete healing of almost all grades is observed 3 months after injury. Lynch et al. , in a prospective study, showed that mean time to US healing in AAST grade I, II, Ill, and IV injuries was 3.1, 8.2, 12.1, and 20.7 weeks, respectively. Soffer D. et al.  suggest a DUS for splenic lesion follow-up. Some authors have suggested the use of magnetic resonance images .
About 40% of patients treated with standard doses of plasma exchange or IVIg do not improve in the first 4 weeks following treatment80,82. Such disease progression does not imply that the treatment is ineffective, as progression might have been worse without therapy6. Clinicians may consider repeating the treatment or changing to an alternative treatment, but at present no evidence exists that this approach will improve the outcome96,97. A clinical trial investigating the effect of administering a second IVIg dose is ongoing98.
A number of exercise training studies (e.g., 5-10 weeks) incorporating creatine supplementation have shown no increases in total body water (TBW). For example, resistance-trained males who received creatine at a dose of 0.3 g/kg lean body mass/day for 7 days (approximately 20 g/day) followed by 4 weeks at 0.075 g/kg lean body mass/day for 28 days (approximately 5 g/day) experienced no significant change in ICW, ECW, or TBW . Furthermore, resistance-trained males who consumed creatine supplementation (20 g/day for seven days followed by 5 g/day for 21 days) had no significant increase in ICW, ECW, or TBW . Similarly, males and females ingesting creatine (0.03 g/kg/day for six weeks) experienced no significant increase in TBW . Six weeks of creatine supplementation in non-resistance-trained males at a dosage of 0.3 g/kg lean body mass for five days followed by 0.075 g/kg lean body mass for 42 days produced no significant changes in TBW . In contrast, when assessing TBW, ICW, and ECW content before and after 28 days of creatine supplementation in healthy males and females (n = 32), Powers et al.  showed that creatine supplementation was effective at increasing muscle creatine content which was associated with an increase in body mass and TBW but did not alter ICW or ECW volumes. In a recent study examining the effects of creatine supplementation combined with resistance exercise for 8 weeks, Ribeiro et al.  found a significant increase in TBW (7.0%) and ICW (9.2%) volume compared to placebo (TBW: 1.7%; ICW: 1.6%), with both groups similarly increasing ECW (CR: 1.2% vs. Placebo = 0.6%). Importantly, the ratio of skeletal muscle mass to ICW remained similar in both groups. It is important to highlight that the ICW is an important cellular signal for protein synthesis and thus drives an increase in muscle mass over time .
From a clinical perspective, creatine supplementation has been found to potentially offer health benefits with minimal adverse effects in younger populations. Hayashi et al.  found improvements in pediatric patients with systemic lupus erythematosus and reported no adverse changes in laboratory parameters of hematology, kidney function, liver function or inflammatory markers after 12 weeks of creatine supplementation. Tarnopolsky et al.  reported significant improvements in fat-free mass and hand grip strength in 30 pediatric patients with Duchenne muscular dystrophy following 4 months of creatine supplementation. Importantly, the creatine supplementation protocol appeared to be well tolerated and did not adversely affect laboratory markers of kidney function, oxidative stress, and bone health [81,82,83]. In addition, Sakellaris et al.  reported significant improvements in traumatic brain injury-related outcomes in children and adolescents who received oral creatine supplementation (0.4 g/kg/day) for 6 months. These neurological benefits may have potential applications for young athletes participating in collision sports, which pose underlying risks of concussions or sub-concussive impacts. Further, several of these clinical trials implemented strict clinical surveillance measures, including continual monitoring of laboratory markers of kidney health, inflammation, and liver function; none of which were negatively impacted by the respective creatine supplementation interventions. These findings support the hypothesis of creatine supplementation likely being safe for children and adolescents. However, perhaps the strongest supporting evidence for the safety of creatine is the recent classification of creatine as generally recognized as safe (GRAS) by the United States Food and Drug Administration (FDA) in late 2020 ( ). Ultimately, this classification indicates that the currently available scientific data pertaining to the safety of creatine, is sufficient and has been agreed upon by a consensus of qualified experts, thereby determining creatine to be safe under the conditions of its intended use ( ). Even though infants and young children are excluded from GRAS, this would still apply to older children and adolescent populations.
The theory that creatine supplementation increases fat mass is a concern amongst exercising individuals, possibly because some experience a gain in body mass from creatine supplementation. However, randomized controlled trials (one week to two years in duration) do not validate this claim. Acute creatine supplementation (7 days) had no effect on fat mass in young and older adults; however, fat-free mass was increased [86, 87]. Furthermore, three weeks of creatine supplementation had no effect on body composition in swimmers . The addition of creatine to high-intensity interval training had no effect on body composition in recreationally active females . In addition, the effects of creatine supplementation during resistance training overreaching had no effect on fat mass . Moreover, in a group of healthy recreational male bodybuilders, 5 g/day of creatine consumed either pre- or post-training had no effect on fat mass . In other short-terms studies lasting 6-8 weeks, there were no changes in fat mass from creatine supplementation. Becque et al.  found no changes in fat mass after six weeks of supplementation plus resistance training. In another 6-week investigation, no significant differences in fat mass or percentage body fat were observed after creatine supplementation . Furthermore, creatine supplementation during an 8-week rugby union football season also had no effect on fat mass . 59ce067264