Translation and cross-cultural adaptation of the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ)

Abstract Objective: To translate and cross-culturally adapt the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) for use in Brazilian Portuguese. The CBBDQ is an 18-item tool covering 10 bladder and 8 bowel symptoms that was developed for use with children of 5 to 12 years of age with bowel and bladder dysfunction (BBD). The instrument has already been validated for use in Dutch and English. Method: In the process of translation and cultural adaptation from English to Portuguese, the CBBDQ was submitted to undergo the required steps as established by the international methodological criteria: forward translation, synthesis, back-translation, expert panel review and pre-testing. Results: Ninety-three parents of children with lower urinary tract dysfunction answered the questionnaire. The mean age of the children was 7.6 ± 2.1 years and 54 were female. Internal consistency was excellent, with a Cronbach's alpha of 0.91 to 0.96. Additionally, reliability was high, with an intraclass correlation coefficient of 0.94 (95%CI: 0.85-0.93; p < 0.0001). Conclusion: The translation and cultural adaptation of the CBBDQ enabled a quantitative evaluation of bladder and bowel symptoms to be performed in Brazilian children. The scores achieved allow the severity of BBD to be evaluated, as well as the patient's progress during treatment. The use of this questionnaire in clinical practice and research will allow more consistent data on BBD to be obtained.

Clinical profile of 93 cases of 46, XY disorders of sexual development in a referral center

ABSTRACT The term DSD refers to disorders that affect the normal process of sexual development causing disagreement between chromosomal, gonadal and phenotypic sex, and this study aimed to describe the clinical profile of a group with DSD 46, XY joined on DSD Clinic of Hospital of Salvador, Bahia Clinics. It was a retrospective study of medical records of survey data of 93 patients with DSD 46, XY. Among the patients studied 50.5% had no defined etiology and 20.4% had androgen insensitivity syndrome (AIS), 63.4% had been initially recorded in males, 31 (33.3%) in females, being that in two it was necessary to reassignment. All patients with complete AIS pure gonadal dysgenesis and had female genitalia. Others have been diagnosed with genital ambiguity or severe hypospadias and cryptorchidism. The gonads were palpable at the first consultation in 75.3% of patients. It is important to establish an active surveillance program for these patients. The first assessment took place before the age of ten in more than 50% of cases, which shows that much needs to be done for medical education and community about the DSD. Because the phenotypic variability of sexual development disorders was noted that the clinical profile of patients studied ranged between different etiologies, including hindering the diagnostic conclusion of these individuals.

Preditores clínicos de bacteriúria assintomática na gestação / Clinical predictors of asymptomatic bacteriuria during pregnancy

OBJETIVOS: Estimar a prevalência de bacteriúria assintomática (BAS) entre gestantes atendidas em pré-natal de Serviço Universitário e identificar prováveis preditores clínicos. MÉTODOS: Estudo prospectivo de corte transversal, envolvendo 260 gestantes matriculadas em serviço de pré-natal de baixo risco entre agosto de 2008 e outubro de 2009, sem sintomas de infecção do trato urinário. Foram excluídas aquelas com febre, disúria, tenesmo vesical, dor lombar, presença de sangramento genital, perda de líquido amniótico, uso de antimicrobianos nos últimos 30 dias e aquelas que não desejaram participar do projeto. A presença de colonização bacteriana ≥10(5) UFC/mL de único patógeno, na amostra urinária obtida do jato médio, foi considerada como a variável dependente. As variáveis estudadas foram: idade, raça, estado civil, nível de instrução, história obstétrica, idade gestacional, anemia, traço falciforme, colpite, passado de infecção do trato urinário, polaciúria, urgência miccional e incontinência urinária. Dados do sumário de urina também foram analisados, como a presença de leucocitúria, flora bacteriana aumentada, hematúria, proteinúria e nitrito. A análise estatística foi realizada com o programa Statistical Package for the Social Sciences (SPSS) 13.0 e a significância estatística foi previamente definida por valor p<0,05. As prevalências foram expressas por percentual e intervalo de confiança considerado foi de 95 por cento. RESULTADOS: A prevalência de foi de 12,3 por cento (IC95 por cento=8,3-16,3). O agente etiológico mais frequente foi a E. coli (59,4 por cento). A regressão logística indicou que a urgência miccional (OR=5,9; IC95 por cento=2,2-16,3; p<0,001), a leucocitúria (OR=2,8; IC95 por cento=1,0-7,8; p=0,04) e a flora bacteriana aumentada (OR=10,6; IC95 por cento=3,9-28,5; p<0,001), são preditores independentes de BAS durante a gestação. CONCLUSÃO: A prevalência de bacteriúria assintomática na população estudada é alta. O escore preditor criado com o modelo final de regressão logística possui uma acurácia de 91,9 por cento para bacteriúria.

PURPOSE: To estimate the prevalence of asymptomatic bacteriuria among pregnant women attended at our university prenatal care clinic and to identify probable clinical predictors. METHODS: Across-sectional study was carried out from August 2008 to October 2009 at the Bahiana School of Medicine involving 260 pregnant women without symptoms of urinary tract infection. The following exclusion criteria were considered: presence of clinical signs such as fever, dysuria, vesical tenesmus, lumbar pain, history of active genital bleeding or loss of amniotic fluid, use of antimicrobial agents in the 30 days prior to sample collection, and refusal to participate in the project. The presence of single pathogen bacterial colonization ≥10(5) CFU/mL in the urine sample obtained from the middle jet was considered to be a dependent variable. The predictive factors evaluated were as follows: age, race, marital status, schooling, gestational age, hypertension, anemia, vaginal infection, sickle cell trait and previous history of urinary tract infection, urinary symptoms related to the lower urinary tract (frequency, urgency and nocturia) and data obtained from the urine summary (leukocyturia, increased bacterial flora, hematuria, proteinuria, and presence of nitrite). Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) software version 13.0 and the level of significance was set at p<0.05. Prevalences were expressed as percentage, and the confidence interval considered was 95 percent (95 percentCI). RESULTS: The prevalence of asymptomatic bacteriuria was 12.3 percent (95 percentCI=8.3-16.3). E. coli was the most frequent etiologic agent (59.4 percent). Logistic regression indicated that urgency to void (OR=5.99; 95 percentCI=2.20-16.31; p<0.001); leukocyturia (OR=2.85; 95 percentCI=1.04-7.83; p=0.042) and increased bacterial flora (OR=10.62; 95 percentCI=3.95-28.56; p<0.001) were independent predictors of asymptomatic bacteriuria. CONCLUSION: The prevalence of asymptomatic bacteriuria in the studied population was high. The prediction score created for the final logistic regression model has an accuracy of 91.9 percent for bacteriuria.