Pharmacological interventions for preventing complications in patients with idiopathic hypercalciuria: A systematic review / Intervenciones farmacológicas para prevenir complicaciones en pacientes con hipercalciuria idiopática: una revisión sistemática

Objective: To assess the effects of pharmacological interventions in patients with idiopathic hypercalciuria. Methods: We performed a search of multiple databases, trial registries, grey literature and conference proceedings up to October 2019. We included randomized and quasi-randomized controlled trials that examined any pharmacological intervention for preventing complications of idiopathic hypercalciuria (given for at least four months and six of follow-up). The primary outcomes were stone-free patients, urinary symptoms and severe adverse events. Results: We included five RCTs (n=446 patients, all adults, 4 in individuals with kidney stones and 1 in postmenopausal women with osteoporosis). Diuretics were likely to increase the number of stone-free patients (RR 1.61, 95% CI 1.33–1.96, moderate quality of evidence (QoE)); 274 more stone-free patients/1000 patients treated (95% CI: 148–432) and produced a slight decrease in the stone formation rate (mean difference −0.18, 95% CI −0.30 to −0.06, low QoE); 180 fewer stones/year/1000 patients treated (95% CI: 300 r to 60). No data on urinary symptoms were reported. The association between diuretic use and severe adverse events was uncertain (RR 5.00, 95% CI 0.60–41.88, very low QoE); 4 more severe adverse events/1000 patients treated (95% CI: 0 fewer to 39 more). Conclusions: The addition of diuretics to a normal or modified diet probably reduces the number of stone recurrences and may decrease the stone formation rate. It is uncertain whether diuretics increase the occurrence of severe adverse events. There were no studies investigating other outcomes or in children. (AU)

Objetivo: Evaluar los efectos de intervenciones farmacológicas en pacientes con hipercalciuria idiopática. Métodos: Realizamos una búsqueda en múltiples bases de datos, registros de ensayos, literatura gris y actas de congresos hasta octubre de 2019. Incluimos ensayos clínicos aleatorizados y cuasialeatorizados que examinaban cualquier intervención farmacológica para prevenir las complicaciones de la hipercalciuria idiopática (mínimo 4 meses de intervención y 6 meses de seguimiento). Los outcomes primarios fueron pacientes libres de cálculos, síntomas urinarios y efectos adversos graves. Resultados: Incluimos 5 RCT (n=446 pacientes, todos adultos, 4 en individuos con cálculos renales y uno en mujeres posmenopáusicas con osteoporosis). Los diuréticos aumentaban probablemente el número de pacientes libres de cálculos (RR 1,61; IC 95%: 1,33 a 1,96, moderada calidad de evidencia [QoE]); 274 más pacientes libres de cálculos/1.000 pacientes tratados (IC 95%: 148 a 432) y producían una ligera disminución en la tasa de formación de cálculos (diferencia media −0,18; IC 95%: −0,30 a −0,06, baja QoE); 180 menos cálculos/año/1.000 pacientes tratados (IC 95%: 300 a 60). No se informaron datos sobre síntomas urinarios. La asociación entre el uso de diuréticos y los efectos adversos graves fue incierta (RR 5,00; IC 95%: 0,60 a 41,88, muy baja QoE); 4 efectos adversos severos más/1.000 pacientes tratados (IC 95%: 0 a 39). Conclusiones: Los diuréticos añadidos a una dieta normal o modificada probablemente reducen la aparición de cálculos y pueden disminuir su tasa de formación. Es incierto si los diuréticos incrementan la ocurrencia de efectos adversos graves. No se encontraron estudios que investigaran otros outcomes o realizados en niños. (AU)

Pharmacological interventions for preventing complications in patients with idiopathic hypercalciuria: A systematic review.

OBJECTIVE: To assess the effects of pharmacological interventions in patients with idiopathic hypercalciuria. METHODS: We performed a search of multiple databases, trial registries, grey literature and conference proceedings up to October 2019. We included randomized and quasi-randomized controlled trials that examined any pharmacological intervention for preventing complications of idiopathic hypercalciuria (given for at least four months and six of follow-up). The primary outcomes were stone-free patients, urinary symptoms and severe adverse events. RESULTS: We included five RCTs (n=446 patients, all adults, 4 in individuals with kidney stones and 1 in postmenopausal women with osteoporosis). Diuretics were likely to increase the number of stone-free patients (RR 1.61, 95% CI 1.33-1.96, moderate quality of evidence (QoE)); 274 more stone-free patients/1000 patients treated (95% CI: 148-432) and produced a slight decrease in the stone formation rate (mean difference -0.18, 95% CI -0.30 to -0.06, low QoE); 180 fewer stones/year/1000 patients treated (95% CI: 300 r to 60). No data on urinary symptoms were reported. The association between diuretic use and severe adverse events was uncertain (RR 5.00, 95% CI 0.60-41.88, very low QoE); 4 more severe adverse events/1000 patients treated (95% CI: 0 fewer to 39 more). CONCLUSIONS: The addition of diuretics to a normal or modified diet probably reduces the number of stone recurrences and may decrease the stone formation rate. It is uncertain whether diuretics increase the occurrence of severe adverse events. There were no studies investigating other outcomes or in children.

Pharmacological interventions for preventing complications in patients with idiopathic hypercalciuria: A systematic review.

OBJECTIVE: To assess the effects of pharmacological interventions in patients with idiopathic hypercalciuria. METHODS: We performed a search of multiple databases, trial registries, grey literature and conference proceedings up to October 2019. We included randomized and quasi-randomized controlled trials that examined any pharmacological intervention for preventing complications of idiopathic hypercalciuria (given for at least four months and six of follow-up). The primary outcomes were stone-free patients, urinary symptoms and severe adverse events. RESULTS: We included five RCTs (n=446 patients, all adults, 4 in individuals with kidney stones and 1 in postmenopausal women with osteoporosis). Diuretics were likely to increase the number of stone-free patients (RR 1.61, 95% CI 1.33-1.96, moderate quality of evidence (QoE)); 274 more stone-free patients/1000 patients treated (95% CI: 148-432) and produced a slight decrease in the stone formation rate (mean difference -0.18, 95% CI -0.30 to -0.06, low QoE); 180 fewer stones/year/1000 patients treated (95% CI: 300 r to 60). No data on urinary symptoms were reported. The association between diuretic use and severe adverse events was uncertain (RR 5.00, 95% CI 0.60-41.88, very low QoE); 4 more severe adverse events/1000 patients treated (95% CI: 0 fewer to 39 more). CONCLUSIONS: The addition of diuretics to a normal or modified diet probably reduces the number of stone recurrences and may decrease the stone formation rate. It is uncertain whether diuretics increase the occurrence of severe adverse events. There were no studies investigating other outcomes or in children.

Relació entre les aportacions enterals de vitamina D I els nivells plasmàtics en nadons prematurs / Relación entre las aportaciones enterales de vitamina D y los niveles plasmáticos en recién nacidos prematuros / Relationship between the enteral intake of vitaminD and plasma levels in premature newborns

FONAMENT: En els prematurs, uns nivells inadequats de vitamina D poden comportar més comorbiditat, però hi ha controvèrsia en les recomanacions de suplementació. OBJECTIU: Intentar correlacionar aportacions (dieta I suplementació) de vitamina D amb nivells inadequats d'aquesta vitamina. MÉTODE: Estudi descriptiu retrospectiu dels prematurs als quals se'ls determina calcifediol (25(OH)D3) entre els mesos de gener I desembre del 2016 al nostre centre. RESULTATS: Incloem 36 determinacions de 25(OH)D3 de 17 nadons (58,8% de sexe masculí) amb mediana d'edat gestacional de 29,8 setmanes (rang: 24,85-35,14) I mediana de pes de 980 g (rang: 420-2.220 g). La mediana d'edat en dies en el moment de l'extracció és 58,5 (rang: 6-188); la mediana de 25(OH)D3 és 53,92ng/ml (rang: 17,1-150). Segons el càlcul de les aportacions de vitamina D, s'obté una mediana de 885 U/dia (rang: 2-1416). Hi ha una correlació estadísticament significativa entre 25(OH)D3 plasmàtica I aportacions. El 75% que rep aportacions de <400 U tenen nivells insuficients; el 62,5% que rep >1.200 U tenen nivells tòxics. Dels que reben 400-1.200 U, el 84% tenen nivells òptims; hi ha diferència entre els que reben 400-800 U, amb un 60% amb nivells suficients, I els que reben 800-1.200 U, amb un 92% amb nivells adequats. Hi ha diferència en el percentatge de mostres amb nivells insuficients segons la classificació de 2009 respecte de l'actual. CONCLUSIONS: Les aportacions de vitamina D d'entre 800 I 1.200 U/dia s'associen a nivells òptims en un percentatge elevat de nadons. Les aportacions inferiors a 400 U o superiors a 1.200 U s'associen a nivells inadequats. L'alimentació per si sola no garanteix els requeriments necessaris de vitamina D, però és una dada essencial que s'ha de tenir en compte. Cal individualitzar la dosi segons els nivells plasmàtics

FUNDAMENTO: En los prematuros, unos niveles inadecuados de vitamina D pueden comportar mayor comorbilidad, pero existe controversia en las recomendaciones de suplementación. OBJETIVO: Intentar correlacionar aportaciones (dieta y suplementación) de vitamina D con niveles inadecuados de esta vitamina. MÉTODO: Estudio descriptivo retrospectivo de los prematuros a los que se les realiza determinación de calcifediol (25(OH)D3) entre enero y diciembre de 2016 en nuestro centro. RESULTADOS: Incluimos 36 determinaciones de 25(OH)D3 de 17 pacientes (58,8% de sexo masculino) con mediana de edad gestacional de 29,8 semanas (rango: 24,85-35,17) y mediana de peso de 980 g (rango: 420-2.220 g). La mediana de edad en días en el momento de la extracción es 58,5 (rango: 6-188); la mediana de 25(OH)D3 es 53,92 ng/ml (rango: 17,1-150). Según el cálculo de los aportes de vitamina D, se obtiene una mediana de 885 U/día (rango: 2-1.416). Existe una correlación estadísticamente significativa entre niveles de 25(OH)D3 y aportes. El 75% que recibe aportes de <400 U tienen niveles insuficientes; el 62,5% que recibe >1.200 U tienen niveles tóxicos. De los que reciben 400-1200 U, el 84% tienen niveles óptimos; existe diferencia entre aquellos que reciben 400-800 U, con un 60% con niveles suficientes, y los que reciben 800-1.200 U, con un 92% con niveles adecuados. Existe diferencia en el porcentaje de muestras con niveles insuficientes según la clasificación de 2009 versus la actual. CONCLUSIONES: Los aportes de vitamina D entre 800 y 1.200 U/día se asocian a niveles óptimos en un porcentaje elevado de prematuros. Las aportaciones inferiores a 400 U o superiores a 1.200 U se asocian a niveles inadecuados. La alimentación por sí sola no garantiza los requerimientos necesarios de vitamina D, pero es un dato esencial a tener en cuenta. Es necesario individualizar la dosis en función de los niveles plasmáticos

BACKGROUND: Inadequate levels of vitamin D in premature newborns may lead to additional comorbidities; however, controversy exists regarding recommendations for supplementation. OBJECTIVE: To analyze correlations between vitamin D intake (diet and supplementation) with inadequate calcifediol (25(OH)D3) levels. METHOD: Descriptive, retrospective study of premature babies, whose 25(OH)D3 levels were determined between January and December 2016, in our medical centre. RESULTS: Thirty-six plasma level determinations of 25(OH)D3 in 17 patients (58.8% male) with median gestational age of 29.8 weeks (range: 24.85-35.14) and median weight of 980g (range 420-2220). The median age in days was 58,5 (range: 6-188) at the moment of determination, and the median plasma level of 25(OH)D3 was 53,92ng/ml (range:17.1-150). The median vitamin D intake was 885U/day (range: 2-1416). There was a significant correlation between 25(OH)D3 levels and vitamin D intake. Seventy-five percent of patients who received <400U intake had insufficient levels; and 62,5% who received >1200 had toxic levels. Eighty-four percent of those who received between 400 and 1200U had adequate levels; 60% of premature newborns who received 400-800U had sufficient levels versus 92% of babies who received 800 to 1200U. There were differences in percentage of samples with insufficient levels according to 2009 classification versus the current one. CONCLUSIONS: In a high percentage of premature babies, 800-1200U vitamin D intake result in adequate levels. Vitamin D in-take of <400U or >1200U correlate with inadequate levels. It is important to consider that nutrition by itself doesn't guarantee the required vitamin D intake. Individualized doses are needed according to blood plasma levels

Osteomielitis de pelvis. Un repte diagnòstic / Osteomielitis de pelis. Un reto diagnóstico / Osteomyelitis of the pelvic bones. A diagnostic challenge

Introducció: l' osteomielitis de pelvis és una patologia poc freqüent que representa el 10% de les osteomielitis. La baixa incidència i la simptomatologia inespecífica pot portar a un retard en el diagnòstic i en la instauració d'un tractament adequat. Cas clínic: pacient de 6 anys amb febre i quadre respiratori de 3 dies d'evolució, associat a dolor i impotència funcional de maluc esquerre, motiu pel qual es fa analítica (normal), radiografia de tòrax (discret infiltrat hilar dret) i ecografia que mostra mínim líquid a l'articulació coxofemoral. S'orienta com a sinovitis transitòria de maluc. Per persistència de la clínica, el novè dia es repeteix l'analítica (hemograma normal, proteïna C reactiva 5,7mg/dl) i hemocultiu que resulta positiu per a Staphylococcus aureus. Es fa ressonància magnètica que és compatible amb osteomie-litis d'isqui. Rep tractament amb cloxacil•lina endovenosa i posteriorment amb amoxicil•linaclavulànic oral fins a completar 6 setmanes, amb una evolució favorable. Comentaris: el diagnòstic diferencial de la coixesa en l'infant inclou bàsicament l'artritis sèptica, l'osteomielitis i la sino-vitis transitòria. El context de quadre respiratori i l'analítica normal, tot i afavorir el diagnòstic de sinovitis, no exclou la possibilitat dels altres quadres que per la seva gravetat i possibles conseqüències cal tenir presents

Introducción. La osteomielitis de pelvis es una patología poco frecuente, que representa menos del 10% de las osteomielitis. La baja incidencia y la sintomatología inespecífica suelen conducir a un retraso en el diagnóstico y en la instauración de un tratamiento adecuado. Caso clínico. Paciente de 6 años con fiebre y cuadro respiratorio de 3 días de evolución, asociado a dolor e impotencia funcional de cadera izquierda, por lo que se realiza analítica (normal), radiografía de tórax (discreto refuerzo hiliar derecho) y ecografía de cadera que muestra mínimo derrame en articulación coxo-femoral izquierda. Se orienta como sinovitis transtoria de cadera. Por persistencia de la clínica, el noveno dia se repite analítica (hemograma normal, proteína C reactiva 5,7mg/dl) y hemocultivo, que resulta positivo para Staphylococcus aureus. Se realiza resonancia magnética nuclear, que resulta compatible con osteomielitis de isquion. Se inicia tratamiento con cloxacilina endovenosa y posteriormente con amoxicilina-clavulánico oral hasta completar 6 semanas, con buena evolución clínica. Comentarios. El diagnóstico diferencial de la cojera en el niño incluye básicamente la artritis séptica, la osteomielitis y la sinovitis transitoria de cadera. El contexto de cuadro respiratorio y analítica normal, pese a que favorece el diagnóstico de sinovitis, no excluye la posibilidad de los demás cuadros que, por su gravedad y posibles consecuencias, debemos tener en mente (AU)

Introduction. Pelvic osteomyelitis is a rare disease, representing only 10% of all cases of osteomyelitis in children. The low incidence and non-specific symptoms that some patients may present can lead to a delayed diagnosis and treatment. Case report. A 6-year-old child presented to the emergency department with a 3-day history of fever and respiratory symptoms associated with the development of left hip pain and limping. White blood cell count and C-reactive protein were within normal range; a chest X-ray showed mild right hilar enlargement, and a left hip ultrasound disclosed a small effusion in the hip joint. The patient was discharged with the diagnosis of transient synovitis. The symptoms persisted and on day 9 the C-reactive protein was noted to be 5.7 mg/dL, with a normal white blood cell count. A blood culture was positive for Staphylococcus aureus, and a magnetic resonance imaging suggested osteomyelitis of the ischium. The patient was then started on intravenous cloxacillin, with good clinical response. He completed a 6-week course of oral amoxicillin- clavulanate. Comments. The differential diagnosis of a limping child includes septic arthritis, osteomyelitis, and transient synovitis. A normal blood test or concomitant respiratory symptoms shouldn’t exclude the diagnosis of osteomyelitis or septic arthritis (AU)

Reflujo vesico-ureteral en pediatría: ¿ha cambiado el papel de la cistografía? / Vesicoureteral reflux in pediatrics: has the role of voiding cystourethrogram changed?

Fundamento. El diagnóstico precoz del reflujo vesicoureteral(RVU) puede ayudar a evitar el desarrollo deReflux vesicoureteral en pediatria: ha canviat elpaper de la cistografia?Ester Parada, Nabil Abu-Hadwan, Francesc Mir, José Maria Inoriza, Teresa Carrión,Joan Manel Torres, Joan Agulló, Pere Plaja.Hospital de Palamós. Palamós (Girona)nefropatía de reflujo pero a la vez puede condicionar eluso demasiado generalizado de exploraciones complementariasinvasivas. Es necesario valorar periódicamente elrendimiento de las exploraciones complementarias que solicitamosen el marco de la mejora de las técnicas de diagnóstico,tanto prenatal como postnatal.Objetivo. Valorar las indicaciones y el rendimiento dela CUMS en el estudio de alteraciones renales de diagnósticoprenatal y en el seguimiento de las infecciones deltracto urinario (ITU).Método. Revisión retrospectiva de las historias clínicasde pacientes de 0-4 años en los que se ha realizado unaCUMS en nuestro hospital entre enero de 2001 y agosto de2004.Resultados. Se han estudiado 128 pacientes, en el 75%de los cuales se solicitó CUMS a raíz del diagnóstico de ITUy en el resto como seguimiento de alteraciones renales dediagnóstico prenatal. Se detectó RVU en el 17.2% de lospacientes: el 12.9% de los estudiados por diagnóstico prenataly el 18.7% por ITU. Dos de los pacientes presentaronuna infección de orina post-CUMS.Conclusiones. A pesar de los avances en el diagnósticoprenatal, la presencia de RVU en el 18.7% de los pacientescon antecedente de ITU avala el papel de la CUMS en el estudiode estos pacientes

Background. The early diagnosis of vesicoureteral reflux(VUR) is important for the prevention of its progressionto reflux nephropathy; however, invasive and uncomfortabletechniques are required. The use of suchprocedures ought to be assessed periodically in the evolvingscenario of technological advances in prenatal andpostnatal diagnosis.Objective. To assess the yield of voiding cystourethrogram(VCUG) in the evaluation of congenital renal abnormalitiesand urinary tract infections (UTI).Method. We retrospectively reviewed the medicalcharts of patients younger than 4 years of age who underwentVCUG between January 2001 and August 2004 at ourhospital.Results. One-hundred and twenty-eight patients underwentVCUG during the study period, 75% of them aftera UTI and the rest because of prenatal diagnosis of renalmalformations. RVU was diagnosed in 17.2% of thepatients: 12.9% of patients with renal malformations and18.7% of patients with history of UTI. Two patients developeda UTI after the VCUG was performed. DMSA scanwas performed in 18 of the 22 patients with VUR, and 12of them were found to have renal scarring. Conclusions. Despite the improvements in prenataldiagnosis of renal malformations, the detection of VUR ina significant proportion of patients as a result of a UTIconfirms the importance of VCUG in the evaluation ofpatients with UTI

Nonmedical costs associated with rotavirus disease requiring hospitalization.

BACKGROUND: As the most common cause of severe diarrhea among children, rotavirus has a significant economic impact. Previous studies focused on the direct medical costs of rotavirus infections; however, nonmedical costs account for the majority of the financial burden from this disease. Herein, we report the results from the largest prospective study in the United States determining the nonmedical costs of severe rotavirus infections. METHODS: Prospective, active, gastroenteritis case surveillance was conducted between November 1997 and December 1999 at 3 pediatric medical centers. Rotavirus infection was identified for 548 children admitted between 2 weeks and 5 years of age. Detailed information about nonmedical costs during the prehospitalization, hospitalization and posthospitalization periods was obtained through interviews. RESULTS: The average nonmedical cost per case of rotavirus disease was USD $448.77, including $359.04 for missed work, $56.66 for transportation, $11.90 for oral rehydration solutions, $9.59 for diapers, $6.83 for child care changes, $3.82 for special foods and $0.93 for formula changes. More than one-half of these expenses (53%) occurred outside the hospitalization period, and 80% of the cost was attributable to missed work. CONCLUSIONS: With an estimated 50,000 hospitalizations attributable to rotavirus each year in the United States, the nonmedical costs of severe rotavirus infections may exceed USD $22 million annually. Previous cost effectiveness analyses of rotavirus vaccines substantially underestimated this burden, suggesting that the nonmedical costs associated with mild to moderate rotavirus disease have been similarly underestimated. These findings are needed to assess accurately the cost effectiveness of future rotavirus immunization strategies.

Prevalence and genetic characterization of caliciviruses among children hospitalized for acute gastroenteritis in the United States.

Human calicivirus was the first recognized viral agent causing gastroenteritis in humans. Norovirus (NV) and Sapovirus (SV), two genera within the Caliciviridae family, cause epidemic and endemic acute gastroenteritis in children and adults. The role of these viruses as a cause of sporadic acute gastroenteritis in young children requiring hospitalization is not well established. The aim of this study was to assess the prevalence and genetic diversity of caliciviruses among children hospitalized with symptoms of acute gastroenteritis. Stool samples were collected over 2 years from symptomatic children (N=1840) up to 5 years of age at three pediatric hospitals in the US. Overall, 156 (8.5%) samples were CV-positive, 131 (7.1%) confirmed by sequencing to be NV and 25 (1.4%) confirmed to be SV. Sequences of RT-PCR-amplified polymerase gene segments were analyzed using distance, maximum likelihood and parsimony algorithms. Phylogenetic analysis of 97 NV sequences showed that seven strains were in genogroup I, 86 strains were in genogroup II and four strains were not in genogroup I, II, or III, likely representing three new NV genogroups IV, VI and VII. Genogroup I and genogroup II strains were in 12 new genetic clusters, three in genogroup I and nine in genogroup II. Within genogroups I and II, most (98%) NV strains were in genetic clusters with no known prototype in GenBank. Phylogenetic analysis of 24 SV strains showed that half grouped with the London/92 strain in one genogroup and the remainder in three other proposed genogroups, one novel. In conclusion, NV and SV were frequent causes of hospitalization for acute gastroenteritis in young children and infecting strains were highly diverse, including newly recognized genogroups and genetic clusters within known genogroups.