Decreased percent change in renal pelvis diameter on diuretic functional magnetic resonance urography following administration of furosemide may help characterize unilateral uretero-pelvic junction obstruction.

BACKGROUND: A well-established definition of obstruction in the setting of congenital hydronephrosis is lacking. Multiple imaging modalities and radiographic characteristics or parameters have been described to help confirm the diagnosis of ureteropelvic junction obstruction (UPJO). We sought to evaluate the change in anterior-posterior renal pelvic diameter (APRPD) following furosemide administration in patients with unilateral hydronephrosis and confirmed UPJO on functional magnetic resonance urography (fMRU) who underwent pyeloplasty. MATERIALS AND METHODS: There were 49 patients who met inclusion criteria (11 females, 38 males; average age 2.2 years, SD 3.4 years) from February 2006 to September 2020, diagnosed with unilateral hydronephrosis (SFU Grade 3-4) who underwent fMRU prior to pyeloplasty for confirmed UPJO. 29 of the included patients also underwent a post-pyeloplasty fMRU. A weight-adjusted dose of 1 mg/kg of furosemide (max 20 mg/kg) was administered intravenously. Two board-certified pediatric radiologists measured the APRPD of the obstructed and non-dilated kidneys prior to pyeloplasty and APRPD of the hydronephrotic kidneys on the post-pyeloplasty follow up fMRUs. Measurements were performed on images prior to and approximately 30 min following furosemide injection. RESULTS: The average APRPD before furosemide injection in the obstructed kidney prior to pyeloplasty was 26.3 mm (SD 9.0 mm) compared to the non-dilated (not obstructed) kidney measurement of 5.1 mm (SD 3.6 mm) (p < 0.001). Following administration of furosemide, the average APRPD was 31.4 mm (SD 8.8 mm) in the obstructed kidney, and 7.8 mm (SD 4.1 mm) in the non-dilated kidney (p < 0.001). After pyeloplasty, the pre-furosemide APRPD measurement was 17.8 mm (SD 11 mm), which was significantly less compared to the pre-pyeloplasty APRPD (p < 0.001). The post-pyeloplasty, post-furosemide APRPD measurement was 25.8 mm (SD 12 mm), also significantly less compared to the pre-pyeloplasty measurement (p = 0.02). The changes in APRPD in the obstructed kidney prior to pyeloplasty was 5.1 mm (SD 3.5 mm) and after pyeloplasty was 8 mm (SD 4.6 mm) (p = 0.002). Change in APRPD in the non-dilated kidney was 2.7 mm (SD 2.3 mm). Percent APRPD change in the obstructed kidney was 22.9% (SD 18.5%), which was significantly less than 33.3% (SD 22.1%) in the post-pyeloplasty kidney (p = 0.028) and 82.8% (SD 87.9%) in the non-dilated kidney (p < 0.001). CONCLUSIONS: A relatively smaller change in APRPD on fMRU following administration of furosemide in the setting of UPJO may serve as another predictive characteristic of obstructed kidneys.

Use of the Community Assessment for Public Health Response (CASPER) method to assess influenza vaccination and activity in Brazos County, Texas.

OBJECTIVES: Based on an increase in influenza cases in Brazos County, Texas, a Community Assessment for Public Health Emergency Response (CASPER) was conducted by the Brazos County Health Department (BCHD) and the Texas A&M School of Public Health's EpiAssist program. The goal of the CASPER was to supplement other data sources to assess vaccination rates and influenza prevalence in the community during a period of high influenza activity nationwide. METHODS: Using the Centers for Disease Control and Prevention's (CDC) CASPER toolkit, 30 census blocks in Brazos County were selected probability proportionate to population size. Seven interviews were attempted in each selected census block by an interview team. The survey contained 21 questions in 5 domains, including demographics, general infection control knowledge, prior infection with influenza, prior experience with influenza vaccine, and attitudes towards influenza vaccination. Survey results were entered into a database for the calculation of frequencies, crude odds ratios (OR), and 95% confidence intervals (CI). RESULTS: Two-hundred and seven households completed the survey. Estimated vaccination rates in Brazos County adults were higher than Texas adults overall, but rates did not differ among children. Forty-two (20.4%) of respondents reported having influenza illness during the month of December 2017. Overall, respondents were knowledgeable of influenza transmission and prevention and reported few barriers and objections to the vaccine; however, some responses suggest misinformation that could be addressed through communication from local health departments exists. African American/Black respondents were less likely to receive a vaccine than respondents of other races, while individuals age 65 and over as well as those who believed the vaccine to be effective were more likely to be vaccinated. CONCLUSION: CASPER should be considered a tool for assessing influenza vaccine and disease status of communities and has potential for providing information useful in the development of public health initiatives.