História digital baseada na experiência de sintomas urinários e intestinais na infância: um estudo metodológico de produção tecnológica / Digital story based on the experience of bladder and bowel symptoms in childhood: a methodological study of technological production

OBJETIVO: Descrever a produção de protótipo de história digital baseada na experiência de sintomas urinários e intestinais em crianças. MÉTODO: Trata-se de pesquisa aplicada, com abordagem multimétodo, dividida em 2 fases: fase 1 consistiu em uma revisão sistemática de métodos mistos e um estudo de método misto (etapa quantitativa baseada em estudo retrospectivo do tipo documental por meio da análise de prontuários, e etapa qualitativa baseada em entrevistas com profissionais especialistas, responsáveis e crianças com sintomas urinários e intestinais em idade escolar). A fase 2 foi uma pesquisa metodológica de produção tecnológica do protótipo de história digital. RESULTADOS: A partir da triangulação dos dados obtidos nas 2 fases da pesquisa multimétodo, a história desenvolvida trouxe personagens representativos do perfil de crianças com os sintomas estudados e uma narrativa com elementos da experiência desses sintomas. CONCLUSÃO: A história buscou dar protagonismo e encorajar crianças com tais sintomas para tratamento e autocuidado.

OBJECTIVE: To describe the production of a prototype digital story based on the experience of bladder and bowel symptoms in children. METHOD: This is an applied research with a multimethod approach, divided into two phases: Phase 1 consisted of a systematic review of mixed methods and a mixed methods study (quantitative phase based on retrospective documentary analysis of medical records, and qualitative phase based on interviews with health professionals, caregivers, and children with bladder and bowel symptoms of school age). Phase 2 consisted of a methodological study of the technological production of the digital story prototype. RESULTS: Based on the triangulation of data obtained in the two phases of the multimethod research, the developed story brought representative characters of the profile of children with the studied symptoms and a narrative with elements of the experience of these symptoms. CONCLUSION: The story sought to give protagonism and encourage children with such symptoms to treatment and self-care.

Severe urinary tract damage secondary to primary bladder neck obstruction in women.

OBJECTIVE: To present the clinical and radiological characteristics of women with severe structural deterioration of the bladder and upper urinary tract secondary to Primary Bladder Neck Obstruction (PBNO), and their outcomes after bladder neck incision (BNI). METHODS: Retrospective evaluation of adult women who underwent BNI for PBNO at one institution. Patients were assessed for symptoms, renal function, structural abnormalities of the urinary tract and video-urodynamics. PBNO diagnosis was confirmed with video-urodynamics in all patients. BNI was performed at the 4-5 and/or 7-8 o'clock positions. Postoperative symptoms, PVR, uroflowmetry and renal function were evaluated and compared to baseline. RESULTS: Median patient age was 56.5 years (range 40-80). All presented with urinary retention-four were on clean intermittent Catheterization (CIC) and two with a Foley catheter. All patients had bladder wall thickening and diverticula. Four women had elevated creatinine levels, bilateral hydronephrosis was present in five (83.3%). After BNI, all patients resumed spontaneous voiding without the need for CIC. Median Qmax significantly improved from 2.0 [1.0-4.0] mL/s to 15 [10-22.7] mL/s (p = 0.031). Median PVR decreased from 150 to 46 [22-76] mL (p = 0.031). There were no postoperative complications. Creatinine levels returned to normal in 3/4 (75%) patients. CONCLUSION: PBNO in women may result in severe damage to the bladder and upper urinary tract. Despite severe structural abnormalities of the bladder, BNI was effective in reducing symptoms and improving structural and functional abnormalities of the lower and upper urinary tract.

Estudo clínico e anatomopatológico da urolitíase em cordeiros confinados submetidos à dieta com diferentes concentrações de fósforo / Clinical and anatomopathological study of urolithiasis in feedlot lambs subjected to diets with different phosphorus concentrations

A urolitíase obstrutiva é frequente na ovinocultura e possui etiologia multifatorial, porém o manejo nutricional inadequado é considerado o mais relevante para sua ocorrência. Os objetivos deste estudo foram verificar a influência de duas dietas com diferentes proporções e concentrações de cálcio (Ca) e fósforo (P) no desenvolvimento da urolitíase obstrutiva, e descrever os achados clínicos e anatomopatológicos do sistema urinário de ovinos. Utilizaram-se 30 cordeiros, machos, mestiços das raças Santa Inês e Ile de France, que foram aleatoriamente distribuídos em dois grupos: Grupo 1 (G1, n=15) - Ca:P de 1,9:1 e 0,42% de P; Grupo 2 (G2, n=15) - Ca:P de 1,5:1 e 0,65% de P. As dietas foram fornecidas por 90 dias consecutivos com feno de Coast-cross, farelo de soja, trigo e milho, e água ad libitum. Após o diagnóstico da doença, os cordeiros foram submetidos ao tratamento clínico e cirúrgico, quando necessário. A urolitíase foi detectada em 36,7% (11/30) dos cordeiros, sendo 26,7% assintomáticos e 10% (3/30) apresentaram obstrução uretral. Um cordeiro foi desobstruído após amputação do processo uretral e sondagem uretral; outro foi a óbito por ruptura vesical e uroperitôneo; outro foi sacrificado após uretrostomia perineal e cistostomia sem sucesso. Em ambos os grupos, as alterações histopatológicas renais mais frequentes foram congestão vascular, dilatação e degeneração tubular. A presença de proteínas na luz tubular foi mais pronunciada no G2. As dietas fornecidas, ricas em concentrado, embora com relação Ca:P adequadas, provocaram a calculogênese, o que comprovou que o excesso de minerais e pouca quantidade de volumoso podem causar a enfermidade no rebanho.

Obstructive urolithiasis is common in farmed sheep and has a multifactorial etiology, but inadequate nutritional management is considered the most relevant condition for its occurrence. The objectives of this study were to verify the influence of two diets with different concentrations of calcium (Ca) and phosphorus (P) on the development of obstructive urolithiasis, and to describe the clinical and anatomopathological findings of the urinary system in sheep. Thirty male crossbred Santa Inês and Ile de France lambs were randomly distributed into two groups: Group 1 (G1, n = 15) - Ca: 1.9:1 P and 0.42% P; Group 2 (G2, n = 15) - Ca: P 1.5:1 and 0.65% P. The diets consisting of Coast-cross hay, soybean meal, wheat, and corn were provided for 90 consecutive days with water ad libitum. After the diagnosis of the disease, the lambs were subjected to clinical and surgical treatment, when necessary. Urolithiasis was detected in 36.7% (11/30) of lambs, 26.7% were asymptomatic and 10% (3/30) had urethral obstruction. A lamb was unobstructed after amputation of the urethral process and urethral catheterization, one died of bladder and uroperitoneum rupture, and another was sacrificed after the failure of perineal urethrostomy and cystostomy. The most frequent renal histopathological changes were vascular congestion, dilation, and tubular degeneration. Proteins in the tubular lumen were more pronounced in G2. The diets were rich in concentrate and had adequate Ca:P ratios, but caused calculogenesis, showing that excess minerals and a small amount of roughage can cause disease in the herd.

Predictive elements of obstructive urolithiasis in sheep

Background: Urolithiasis is an economically important disease that has considerable significance for sheep farming.With the tissue and biochemical changes resulting from the development of this disease, metabolic disorders and immuneresponse are established. Hemogasometric evaluation allows the identification of systemic acid-base imbalances quickly.Acute phase proteins (APP) have in the last two decades had become the biomarkers of choice in human and veterinarymedicine. To date, no biomarker studies have been published for sheep with obstructive urolithiasis. Thus, this studyaimed to analyze the hemogasometric kinetics in obstructive urolithiasis in sheep and the APP that can be used as earlybiomarkers in this disease.Materials, Methods & Results: In this study, 14 healthy male Santa Inês sheep, aged approximately 90 days, were fed oncalculogenic diet for 120 days. The sheep were examined weekly to observe the clinical signs. Blood and urine analysiswere also performed. For comparative analysis purposes, at the end of the experiment, sheep that developed obstructiveurolithiasis were extracted from the initial experimental group D1 (without urolithiasis) and moved to the second experimental group D2 (with urolithiasis). In the pre-experimental period and on the day of slaughter, venous blood was sampledfor hemogasometric tests, with a maximum time of 15 minutes between collection and analysis to ensure the reliability ofthe results obtained. The pH, pCO2, pO2, EB, tCO2, HCO3-, stHCO3-, tHb, sO2 and Hct, Na+, K+ and Ca2+ ions were quantified. To identify and measure immunoglobulins (A and G) and APP, samples from sheep that developed obstructive urolithiasis (D2) were analyzed. Blood samples were harvested weekly until the clinical...(AU)

Predictive elements of obstructive urolithiasis in sheep

Background: Urolithiasis is an economically important disease that has considerable significance for sheep farming.With the tissue and biochemical changes resulting from the development of this disease, metabolic disorders and immuneresponse are established. Hemogasometric evaluation allows the identification of systemic acid-base imbalances quickly.Acute phase proteins (APP) have in the last two decades had become the biomarkers of choice in human and veterinarymedicine. To date, no biomarker studies have been published for sheep with obstructive urolithiasis. Thus, this studyaimed to analyze the hemogasometric kinetics in obstructive urolithiasis in sheep and the APP that can be used as earlybiomarkers in this disease.Materials, Methods & Results: In this study, 14 healthy male Santa Inês sheep, aged approximately 90 days, were fed oncalculogenic diet for 120 days. The sheep were examined weekly to observe the clinical signs. Blood and urine analysiswere also performed. For comparative analysis purposes, at the end of the experiment, sheep that developed obstructiveurolithiasis were extracted from the initial experimental group D1 (without urolithiasis) and moved to the second experimental group D2 (with urolithiasis). In the pre-experimental period and on the day of slaughter, venous blood was sampledfor hemogasometric tests, with a maximum time of 15 minutes between collection and analysis to ensure the reliability ofthe results obtained. The pH, pCO2, pO2, EB, tCO2, HCO3-, stHCO3-, tHb, sO2 and Hct, Na+, K+ and Ca2+ ions were quantified. To identify and measure immunoglobulins (A and G) and APP, samples from sheep that developed obstructive urolithiasis (D2) were analyzed. Blood samples were harvested weekly until the clinical...

Application of data mining techniques to explore predictors of upper urinary tract damage in patients with neurogenic bladder.

This study proposed a decision tree model to screen upper urinary tract damage (UUTD) for patients with neurogenic bladder (NGB). Thirty-four NGB patients with UUTD were recruited in the case group, while 78 without UUTD were included in the control group. A decision tree method, classification and regression tree (CART), was then applied to develop the model in which UUTD was used as a dependent variable and history of urinary tract infections, bladder management, conservative treatment, and urodynamic findings were used as independent variables. The urethra function factor was found to be the primary screening information of patients and treated as the root node of the tree; Pabd max (maximum abdominal pressure, >14 cmH2O), Pves max (maximum intravesical pressure, ≤89 cmH2O), and gender (female) were also variables associated with UUTD. The accuracy of the proposed model was 84.8%, and the area under curve was 0.901 (95%CI=0.844-0.958), suggesting that the decision tree model might provide a new and convenient way to screen UUTD for NGB patients in both undeveloped and developing areas.

Validation of self - confidence scale for clean urinary intermittent self - catheterization for patients and health - caregivers

ABSTRACT Objective To validate a measurement instrument for clean intermittent self-catheterization for patients and health-caregivers. Material and Methods Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermittent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form containing 16 items with 5 points each: “no confidence”=1, “little confidence”=2, “confident”=3, “very confident”=4 and “completely confident”=5. Questionnaire called “Self-Confident Scale for Clean Intermittent Self-catheterization” (SCSCISC) was constructed based on literature and previously validated (appearance and content). Results The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at diagonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers. Conclusion The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

Validation of self - confidence scale for clean urinary intermittent self - catheterization for patients and health - caregivers.

OBJECTIVE: To validate a measurement instrument for clean intermittent self-catheterization for patients and health-caregivers. MATERIAL AND METHODS: Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermittent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form containing 16 items with 5 points each: "no confidence"=1, "little confidence"=2, "confident"=3, "very confident"=4 and "completely confident"=5. Questionnaire called "Self- Confident Scale for Clean Intermittent Self-catheterization" (SCSCISC) was constructed based on literature and previously validated (appearance and content). RESULTS: The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at diagonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers. CONCLUSION: The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

Application of data mining techniques to explore predictors of upper urinary tract damage in patients with neurogenic bladder

This study proposed a decision tree model to screen upper urinary tract damage (UUTD) for patients with neurogenic bladder (NGB). Thirty-four NGB patients with UUTD were recruited in the case group, while 78 without UUTD were included in the control group. A decision tree method, classification and regression tree (CART), was then applied to develop the model in which UUTD was used as a dependent variable and history of urinary tract infections, bladder management, conservative treatment, and urodynamic findings were used as independent variables. The urethra function factor was found to be the primary screening information of patients and treated as the root node of the tree; Pabd max (maximum abdominal pressure, >14 cmH2O), Pves max (maximum intravesical pressure, ≤89 cmH2O), and gender (female) were also variables associated with UUTD. The accuracy of the proposed model was 84.8%, and the area under curve was 0.901 (95%CI=0.844-0.958), suggesting that the decision tree model might provide a new and convenient way to screen UUTD for NGB patients in both undeveloped and developing areas.

Avaliação clínica, laboratorial e anatomopatológica do sistema urinário de ovinos confinados com ou sem suplementação de cloreto de amônio / Clinical, laboratory and anatomopathological evaluation of the urinary system of feedlot sheep with or without ammonium chloride supplementation

A acidificação urinária com cloreto de amônio (CA) é um método preventivo eficiente em urolitíase obstrutiva em ovinos. Os objetivos deste estudo com ovinos confinados, que receberam dieta concentrada com elevado teor proteico, foram: verificar o efeito da dieta sobre a formação de urólitos e o desenvolvimento da doença; analisar as características macroscópicas e histopatológicas do sistema urinário; relacionar os achados clínicos, laboratoriais e necroscópicos com a presença de urólitos. Utilizaram-se 60 ovinos machos: grupo CA (n=40), 400 mg/kg CA/dia, tratados via oral, por 42 dias consecutivos; grupo-controle (n=20), não tratado. Determinaram-se sete momentos de colheita de amostras com intervalos de sete dias, no total de 56 dias de confinamento. Encontraram-se microcálculos na pelve renal em cinco animais de ambos os grupos. As lesões renais microscópicas mais relevantes foram congestão vascular e necrose tubular. Concluiu-se que a dieta rica em concentrado provocou lesão renal em ambos os grupos, embora sem alterar a função renal, o que foi comprovado em testes pela ureia e creatinina séricas. O cloreto de amônio fornecido ao grupo CA não impediu a calculogênese, mas reduziu sua prevalência em relação ao grupo-controle. Os ovinos do grupo-controle tiveram maior comprometimento renal, pela alta incidência de cristalúria e pela necrose tubular, induzidas pelo consumo da dieta rica em grãos(AU)

The urinary acidification with ammonium chloride (AC) is an efficient preventive method for urolithiasis in sheep. The objectives of this study with feedlot sheep receiving concentrated diet with high protein content were (1) to verify the effect of diet on urolith formation and development of the disease, (2) to analyze the macroscopic and histopathological characteristics of the urinary system, and (3) to relate the clinical, laboratory and necropsy findings with the presence of uroliths. Sixty male sheep were used: AC group (n=40), 400mg/kg AC/day, orally treated for 42 consecutive days, and control group (n=20), untreated. Seven times were determined for sampling with a seven-day interval, totaling 56 days of feedlot. Small uroliths were found in the renal pelvis of five sheep in both groups. The most relevant microscopic renal lesions were vascular congestion and tubular necrosis. It was concluded that the highly concentrated diet caused renal injury in both groups, without changing the renal function, what was proven by laboratory tests of urea and creatinine. Ammonium chloride provided to the CA group did not prevent urolith formation, but reduced its prevalence in comparison with the control group. Sheep of the control group had increased kidney damage, which resulted in higher incidence of crystalluria and tubular necrosis induced by the consumption of a diet rich in grains(AU)

Avaliação clínica, laboratorial e anatomopatológica do sistema urinário de ovinos confinados com ou sem suplementação de cloreto de amônio / Clinical, laboratory and anatomopathological evaluation of the urinary system of feedlot sheep with or without ammonium chloride supplementation

A acidificação urinária com cloreto de amônio (CA) é um método preventivo eficiente em urolitíase obstrutiva em ovinos. Os objetivos deste estudo com ovinos confinados, que receberam dieta concentrada com elevado teor proteico, foram: verificar o efeito da dieta sobre a formação de urólitos e o desenvolvimento da doença; analisar as características macroscópicas e histopatológicas do sistema urinário; relacionar os achados clínicos, laboratoriais e necroscópicos com a presença de urólitos. Utilizaram-se 60 ovinos machos: grupo CA (n=40), 400 mg/kg CA/dia, tratados via oral, por 42 dias consecutivos; grupo-controle (n=20), não tratado. Determinaram-se sete momentos de colheita de amostras com intervalos de sete dias, no total de 56 dias de confinamento. Encontraram-se microcálculos na pelve renal em cinco animais de ambos os grupos. As lesões renais microscópicas mais relevantes foram congestão vascular e necrose tubular. Concluiu-se que a dieta rica em concentrado provocou lesão renal em ambos os grupos, embora sem alterar a função renal, o que foi comprovado em testes pela ureia e creatinina séricas. O cloreto de amônio fornecido ao grupo CA não impediu a calculogênese, mas reduziu sua prevalência em relação ao grupo-controle. Os ovinos do grupo-controle tiveram maior comprometimento renal, pela alta incidência de cristalúria e pela necrose tubular, induzidas pelo consumo da dieta rica em grãos.

The urinary acidification with ammonium chloride (AC) is an efficient preventive method for urolithiasis in sheep. The objectives of this study with feedlot sheep receiving concentrated diet with high protein content were (1) to verify the effect of diet on urolith formation and development of the disease, (2) to analyze the macroscopic and histopathological characteristics of the urinary system, and (3) to relate the clinical, laboratory and necropsy findings with the presence of uroliths. Sixty male sheep were used: AC group (n=40), 400mg/kg AC/day, orally treated for 42 consecutive days, and control group (n=20), untreated. Seven times were determined for sampling with a seven-day interval, totaling 56 days of feedlot. Small uroliths were found in the renal pelvis of five sheep in both groups. The most relevant microscopic renal lesions were vascular congestion and tubular necrosis. It was concluded that the highly concentrated diet caused renal injury in both groups, without changing the renal function, what was proven by laboratory tests of urea and creatinine. Ammonium chloride provided to the CA group did not prevent urolith formation, but reduced its prevalence in comparison with the control group. Sheep of the control group had increased kidney damage, which resulted in higher incidence of crystalluria and tubular necrosis induced by the consumption of a diet rich in grains.

URINARY DYSFUNCTION AFTER SURGICAL TREATMENT FOR RECTAL CANCER.

BACKGROUND: The impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context. OBJECTIVE: To detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer. METHODS: The present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS) questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student's t-test. RESULTS: Eight (19%) participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P<0.001). None of the variables assessed as potential risk factors exhibited statistical significance, i.e., age, gender, distance from tumour to anal margin, neoadjuvant therapy, adjuvant therapy, type of surgery, surgical approach (laparoscopy or laparotomy), and duration of surgery. CONCLUSION: This study identified an incidence of 19% of moderate to severe urinary dysfunction after 6 months surveillance. No risk factor for urinary dysfunction was identified in this population.

URINARY DYSFUNCTION AFTER SURGICAL TREATMENT FOR RECTAL CANCER / Disfunção urinária após tratamento cirúrgico do câncer de reto

BackgroundThe impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context.ObjectiveTo detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer.MethodsThe present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS) questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student’s t-test.ResultsEight (19%) participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P<0.001). None of the variables assessed as potential risk factors exhibited statistical significance, i.e., age, gender, distance from tumour to anal margin, neoadjuvant therapy, adjuvant therapy, type of surgery, surgical approach (laparoscopy or laparotomy), and duration of surgery.ConclusionThis study identified an incidence of 19% of moderate to severe urinary dysfuction after 6 months surveillance. No risk factor for urinary dysfunction was identified in this population.

ContextoA perda de qualidade de vida atribuída ao tratamento do câncer retal continua elevada. Neste contexto, a deterioração da função urinária é complicação relevante.ObjetivoIdentificar disfunção urinária e seus fatores de risco em doentes submetidos ao tratamento cirúrgico do câncer de reto.MétodosRealizou-se estudo prospectivo com 42 doentes de ambos os sexos submetidos a tratamento cirúrgico com intenção curativa para adenocarcinoma de reto. Foi utilizado o questionário International Prostatic Symptom Score, validado na língua portuguesa, em dois períodos: imediatamente antes e após 6 meses do procedimento cirúrgico. Os fatores de risco para disfunção urinária foram analisados por regressão logística e teste t de Student.ResultadosApós 6 meses do procedimento cirúrgico, oito (19%) doentes apresentaram disfunção urinária moderada a grave e aumento na média do escore utilizado de 1,43 pontos no pré-operatório para 4,62 pontos no pós-operatório (P<0,001). A análise de fatores de risco para disfunção urinária não mostrou significância para as variáveis estudadas, idade, gênero, distância tumoral da margem anal, neoadjuvância, adjuvância, procedimento cirúrgico realizado, via de acesso cirúrgico (laparoscópica ou laparotômica) e tempo operatório.ConclusãoNos doentes com carcinoma retal operados com intenção curativa, a incidência de disfunção urinária moderada a grave após 6 meses da operação foi de 19%. Não foram identificados fatores de risco para disfunção urinária nesses doentes.

Damage of urinary/respiratory system and survival rate is affected by gender in EAE model of Lewis rat

Background: Multiple sclerosis (MS) is a demyelinating chronic inflammatory disease of the central nervous system.Experimental autoimmune encephalomyelitis (EAE) is a widely used model for MS based on autoimmune and histopathological similarities. Women are more susceptible to multiple sclerosis than men. This susceptibility has been attributedto sex hormones, sex-linked gene, and more robust immune responses in females. The aim of this study was to comparesurvival rate and severity of disease in terms of clinic-pathological signs including nasal bleeding, urinary incontinenceand bleeding from urinary tract rate between males and females affected by EAE.Materials, Methods & Results: Lewis rats aged 7-8 weeks were immunized subcutaneously with a homogenate ofguinea pig spinal cord and complete Freunds adjuvant (CFA). Each rat received 50 μg guinea pig spinal cord and 400 μgMycobacterium tuberculosis. Animals were daily weighed and clinical signs of disease were evaluated until day 36 postimmunization. Incidence, survival rate, clinic-pathological signs including nasal bleeding, urinary tract bleeding, and urinaryincontinence were evaluated. To assess the degree of inflammation at the peak of the disease, kidney and lung were dissected,fixed, and examined. The susceptibility to EAE in male and female rats was 100%. The day that the first clinical signs wereobserved was 7 days for both males and females after the immunization. Weight curve of EAE-affected male and femaleanimals were significantly different from their corresponding healthy animals (P < 0.001). The course of clinical scoreshowed a significant difference between males and females (P < 0.04). There was no significance association between sexand incidence. Survival analysis indicated a significant high mortality in male group (P = 0.001). The coagulopathy signin females, including nasal bleeding and urinary incontinence, decreases as disease progresses...(AU)

Damage of urinary/respiratory system and survival rate is affected by gender in EAE model of Lewis rat

Background: Multiple sclerosis (MS) is a demyelinating chronic inflammatory disease of the central nervous system.Experimental autoimmune encephalomyelitis (EAE) is a widely used model for MS based on autoimmune and histopathological similarities. Women are more susceptible to multiple sclerosis than men. This susceptibility has been attributedto sex hormones, sex-linked gene, and more robust immune responses in females. The aim of this study was to comparesurvival rate and severity of disease in terms of clinic-pathological signs including nasal bleeding, urinary incontinenceand bleeding from urinary tract rate between males and females affected by EAE.Materials, Methods & Results: Lewis rats aged 7-8 weeks were immunized subcutaneously with a homogenate ofguinea pig spinal cord and complete Freund’s adjuvant (CFA). Each rat received 50 μg guinea pig spinal cord and 400 μgMycobacterium tuberculosis. Animals were daily weighed and clinical signs of disease were evaluated until day 36 postimmunization. Incidence, survival rate, clinic-pathological signs including nasal bleeding, urinary tract bleeding, and urinaryincontinence were evaluated. To assess the degree of inflammation at the peak of the disease, kidney and lung were dissected,fixed, and examined. The susceptibility to EAE in male and female rats was 100%. The day that the first clinical signs wereobserved was 7 days for both males and females after the immunization. Weight curve of EAE-affected male and femaleanimals were significantly different from their corresponding healthy animals (P < 0.001). The course of clinical scoreshowed a significant difference between males and females (P < 0.04). There was no significance association between sexand incidence. Survival analysis indicated a significant high mortality in male group (P = 0.001). The coagulopathy signin females, including nasal bleeding and urinary incontinence, decreases as disease progresses...

Riesgo de reinfección después de primera infección del tracto urinario en el período neonatal / Risk of reinfection after the first infection of the urinary tract in the neonatal period

Introducción: no se tiene constancia de la frecuencia con que ocurren reinfecciones después de la primera infección del tracto urinario en el período neonatal, ni cuáles son los factores que se asocian a estas. Objetivo: determinar la frecuencia y factores asociados con la ocurrencia de reinfecciones en pacientes que sufrieron la primera infección del tracto urinario en el período neonatal. Métodos: estudio observacional, analítico, longitudinal, desde 1992 hasta 2009, de 399 recién nacidos con la primera infección del tracto urinario, y que se le realizaron ultrasonido renal y uretrocistografía miccional. Los pacientes tuvieron seguimiento por consulta externa y se analizaron la frecuencia y factores clínicos, demográficos y de evaluación de radioimagen, asociados con la ocurrencia de reinfecciones...

Introduction: there is not enough proof of either the frequency of re-infections after the first infection of the urinary tract in the neonatal period, or the factors associated to them. Objective: to determine the frequency and the factors associated to occurrence of re-infections in patients who suffered the first infection of the urinay tract in the neonatal period. Methods: a longitudinal, observational and analytic study of 399 newborns with first infection of the urinary tract was conducted from 1992 to 2009. These patients had been performed renal ultrasound and mictional cystourethrography and they were followed-up in the outpatient service. Frequency, clinical and demographic factors and imaging assessment associated to the occurrence of re-infections were analyzed...

Riesgo de reinfección después de primera infección del tracto urinario en el período neonatal / Risk of reinfection after the first infection of the urinary tract in the neonatal period

Introducción: no se tiene constancia de la frecuencia con que ocurren reinfecciones después de la primera infección del tracto urinario en el período neonatal, ni cuáles son los factores que se asocian a estas. Objetivo: determinar la frecuencia y factores asociados con la ocurrencia de reinfecciones en pacientes que sufrieron la primera infección del tracto urinario en el período neonatal. Métodos: estudio observacional, analítico, longitudinal, desde 1992 hasta 2009, de 399 recién nacidos con la primera infección del tracto urinario, y que se le realizaron ultrasonido renal y uretrocistografía miccional. Los pacientes tuvieron seguimiento por consulta externa y se analizaron la frecuencia y factores clínicos, demográficos y de evaluación de radioimagen, asociados con la ocurrencia de reinfecciones...

Introduction: there is not enough proof of either the frequency of re-infections after the first infection of the urinary tract in the neonatal period, or the factors associated to them. Objective: to determine the frequency and the factors associated to occurrence of re-infections in patients who suffered the first infection of the urinay tract in the neonatal period. Methods: a longitudinal, observational and analytic study of 399 newborns with first infection of the urinary tract was conducted from 1992 to 2009. These patients had been performed renal ultrasound and mictional cystourethrography and they were followed-up in the outpatient service. Frequency, clinical and demographic factors and imaging assessment associated to the occurrence of re-infections were analyzed...

Hepatitis anictérica como manifestación de sífilis congénita / Anicteric Hepatitis as Congenital Syphilis Manifestation

La sífilis congénita es un problema de salud pública mundial, la mayoría de los neonatos infectados no presenta manifestaciones clínicas de la enfermedad y la determinación de Ig M específica utilizada para el diagnóstico es de bajo rendimiento, por lo que el diagnóstico en el recién nacido depende del diagnóstico de sífilis en la gestante. Presentamos la historia clínica de una recién nacida, hija de una madre con sífilis gestacional inadecuadamente tratada. Durante su hospitalización se evidenció compromiso hepático con aumento de la aspartato amino transferasa e hiperbilirrubinemia con aumento de la fracción conjugada. Se descartó compromiso de SNC. Los cultivos para gérmenes comunes de sangre y orina fueron negativos. Las determinaciones de Ig M para CMV, rubeola, toxoplasma , Herpes I y II fueron negativas. Las ecografías transfontanelar, cardiaca, renal y de vías urinarias y hepatobiliar fueron normales. Durante la hospitalización, a los 9 días de vida presentó un episodio de infección bacteriana asociada. Recibió tratamiento con penicilina cristalina durante 14 días con normalización de los niveles de bilirrubina y de aspartato aminotransferasa. El seguimiento clínico y serológico a los 3 meses de edad mostró patrón de crecimiento y desarrollo normal y VDRL no reactiva.

Congenital syphilis is a global public health problem. The majority of infected children have no clinical manifestations of the disease and the specific IgM determination in newborns has low diagnostic performance. The diagnosis depends mostly of the diagnosis in mothers before birth. We report a newborn that was inadequately treated prenatally. At birth, the liver involvement was detected, with increase in aspartate amino transferase and of conjugated fractions of bilirubin. CNS involvement was ruled out and cultures of blood and urine were negative for bacteria. Determinations for IgM of CMV, rubella, toxoplasmosis and herpes I and II, were negative. Transfontanellar, heart, kidney, urinary tract and hepatobiliary ultrasound examinations were normal. Crystalline penicillin treatment for 14 days was undertaken, obtaining normal levels of bilirubin and aspartate aminotransferase at the end of treatment. The clinical and serological follow-up after 3 months showed a normal growth and development pattern with non-reactive VDRL tests.

Antegrade pressure measurement of urinary tract in children with persistent hydronephrosis.

INTRODUCTION: Dilation of urinary tract occurs without the presence of obstruction. Diagnostic methods that depend on renal function may elicit mistaken diagnosis. Whitaker (1973) proposed the evaluation of urinary tract pressure submitted to constant flow. Other investigators proposed perfusion of renal pelvis under controlled pressure, making the method more physiological and reproducible. The objective of the present study was to evaluate the results of the anterograde pressure measurement (APM) of the urinary tract of children with persistent hydronephrosis after surgery suspected to present persistent obstruction. MATERIALS AND METHODS: Along 12 years, 26 renal units with persistent hydronephrosis after surgery (12 PUJ and 14 VUJ) were submitted to evaluation of the renal tract pressure in order to decide the form of treatment. Previous radionuclide scans with DTPA, intravenous pyelographies and ultrasounds were considered undetermined in relation to obstruction in 10 occasions and obstructive in 16. APM was performed under radioscopy through renal pelvis puncture or previous stoma. Saline with methylene blue + iodine contrast was infused under constant pressure of 40 cm H2O to fill the urinary system. The ureteral opening pressure was measured following the opening of the system and stabilization of the water column. RESULTS: Among the 10 cases with undetermined previous diagnosis, APM was considered non-obstructive in two and those were treated clinically and eight were considered obstructive and were submitted to surgery. Among the 16 cases previously classified as obstructive, nine confirmed obstruction and were submitted to surgery. Seven cases were considered non-obstructive, and were treated clinically, with stable DMSA and hydronephrosis. CONCLUSIONS: APM avoided unnecessary surgery in one third of the cases and was important to treatment decision in 100 %. We believe that this simple test is an excellent diagnostic tool when selectively applied mainly in the presence of functional deficit.