The Differential Diagnosis of Sterile Pyuria in Pediatric Patients: A Review

Sterile pyuria is a common finding in pediatric patients. Literature describing the diagnoses as well as clinical characteristics of children with sterile pyuria is lacking. This review was performed to establish an evidence-based approach to the differential diagnosis by way of an extensive literature search. The definition of pyuria is inconsistent. The various causes of pediatric sterile pyuria identified were classified as either Infectious or Non-Infectious. Sub-categories of Infectious causes include: Viral Infection, Bacterial Infection, Other Infections (tuberculosis, fungal, parasitic), Sexually Transmitted Infections, Recent Antibiotic Therapy. Non-Infectious causes include: Systemic Disease, Renal Disease, Drug Related, Inflammation adjacent to Genitourinary Tract. Clinicians that encounter pediatric patients with sterile pyuria and persistent symptoms should consider the substantial differential diagnosis described in this study.

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Diagnostic and Therapeutic Management of a First Unprovoked Seizure in Children and Adolescents With a Focus on the Revised Diagnostic Criteria for Epilepsy

Journal of Child Neurology ◽

10.1177/0883073817706028 ◽

2017 ◽

Vol 32 (8) ◽

pp. 774-788 ◽

Cited By ~ 2

Author(s):

Arnold J. Sansevere ◽

Jennifer Avalone ◽

Lauren Doyle Strauss ◽

Archana A. Patel ◽

Anna Pinto ◽

...

Keyword(s):

Differential Diagnosis ◽

Physical Examination ◽

Children And Adolescents ◽

Diagnostic Criteria ◽

Laboratory Tests ◽

Pediatric Patients ◽

Clinical Presentation ◽

Therapeutic Management ◽

Unprovoked Seizure ◽

Definition Of

By definition, unprovoked seizures are not precipitated by an identifiable factor, such as fever or trauma. A thorough history and physical examination are essential to caring for pediatric patients with a potential first unprovoked seizure. Differential diagnosis, EEG, neuroimaging, laboratory tests, and initiation of treatment will be reviewed. Treatment is typically initiated after 2 unprovoked seizures, or after 1 seizure in select patients with distinct epilepsy syndromes. Recent expansion of the definition of epilepsy by the ILAE allows for the diagnosis of epilepsy to be made after the first seizure if the clinical presentation and supporting diagnostic studies suggest a greater than 60% chance of a second seizure. This review summarizes the current literature on the diagnostic and therapeutic management of first unprovoked seizure in children and adolescents while taking into consideration the revised diagnostic criteria of epilepsy.

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Anticancer Hybrid Combinations: Mechanisms of Action, Implications and Future Perspectives

Current Pharmaceutical Design ◽

10.2174/1381612825666190110162529 ◽

2019 ◽

Vol 24 (36) ◽

pp. 4312-4333 ◽

Cited By ~ 4

Author(s):

Eva M. Domínguez-Martín ◽

Ana M. Díaz-Lanza ◽

Célia M. C. Faustino

Keyword(s):

Paradigm Shift ◽

Molecular Level ◽

Chemotherapeutic Agent ◽

Synergistic Effects ◽

Extensive Literature ◽

Synergistic Interactions ◽

Extensive Literature Search ◽

Preclinical And Clinical Studies ◽

Phytochemical Components ◽

Combination Regimens

The exponential growth of cancer cases worldwide together with recent advances concerning the pathophysiological mechanisms of the disease at the molecular level led to a paradigm shift in chemotherapy, from monotherapy to targeted drug combination regimens. However, adverse effects and the emergence of multidrug resistance (MDR) limit the effectiveness of these therapies. In this context, hybrid combinations mixing anticancer drugs and bioactive phytochemical components from medicinal plants, or even plant extracts, that can act synergistically on multiple targets and signaling pathways represent a promising approach with the potential to expand the current therapeutic arsenal. This review aims to provide a synopsis on anticancer hybrid combinations based on their multi-target mechanisms and synergistic effects from an extensive literature search focusing mainly on publications from the last ten years. In most of these combinations, the phytochemical component was shown to enhance the anticancer activity of the chemotherapeutic agent and to sensitize chemoresistant tumors in several types of cancer. Hybrid combinations, due to synergistic interactions, are also associated with less severe adverse events since lower doses can be used to achieve the same therapeutic effect. Further preclinical and clinical studies are needed, as well as the development of an adequate regulatory framework, before hybrid combination therapy can be translated into clinical practice.

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Recent developments and opportunities in fighting COVID-19

Coronaviruses ◽

10.2174/2666796701999201204120422 ◽

2020 ◽

Vol 01 ◽

Author(s):

Vikram Rao ◽

Subrat Kumar Bhattamisra

Keyword(s):

World Health ◽

Diagnostic Tools ◽

Extensive Literature ◽

Angiotensin Converting Enzyme 2 ◽

Recent Developments ◽

Therapeutic Molecules ◽

Discharged Patients ◽

Extensive Literature Search ◽

Repurposed Drugs ◽

Health Organization

Background: COVID-19, a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2) was first diagnosed in the patients from Wuhan, China in December 2019. Within couple of months of infection, it was declared as pandemic by World health organization. COVID-19 has become the most contagious infection with a serious threat to global health. In this review, we aimed to discuss the pathogenesis, diagnostics, current treatments and potential vaccines for COVID-19. Methods: An extensive literature search was conducted using keywords “COVID-19”; “Coronavirus”; “SARS-Cov-2”; “SARS” in public domains of Google, Google scholar, PubMed, and ScienceDirect. Selected articles were used to construct this review. Results: SARS-Cov-2 uses the Spike (S) protein on its surface to recognize the receptor on angiotensin-converting enzyme 2 (ACE2) and bind with 10-folds greater affinity than SARS-Cov-1. Molecular assays and immunoassays are the most frequently used tests whereas computed tomography (CT) scans, Artificial intelligence enabled diagnostic tools were also used in patients. In therapeutic treatment, few drugs were repurposed and there are 23 therapeutic molecules including the repurposed drugs are in different stages of clinical trial. Similarly, development of vaccines is also in the pipeline. Few countries have managed well to contain the spread by rapid testing and identifying the clusters. Conclusion: Till now, the acute complications and mortality of COVID-19 has been linked to the pre-existing comorbid conditions or age. Besides the development of therapeutic strategies that includes drugs and vaccine, the long term implication of COVID-19 infection in terms of the disorder/disability in the cured/discharged patients is a new area to investigate.

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Paranasal Mass in a Healthy Male Toddler

Ear Nose & Throat Journal ◽

10.1177/01455613211007944 ◽

2021 ◽

pp. 014556132110079

Author(s):

Melonie Anne Phillips ◽

Meredith Lind ◽

Gerd McGwire ◽

Diana Rodriguez ◽

Suzanna Logan

Keyword(s):

Differential Diagnosis ◽

Pediatric Patients ◽

Pediatric Population ◽

Age Group ◽

Significant Morbidity ◽

Healthy Male ◽

Neck Tumors ◽

Complete Surgical Resection ◽

Maxilla And Mandible ◽

Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

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Cognitive Issues in Pediatric Multiple Sclerosis

Brain Sciences ◽

10.3390/brainsci11040442 ◽

2021 ◽

Vol 11 (4) ◽

pp. 442

Author(s):

Emilio Portaccio ◽

Ermelinda De Meo ◽

Angelo Bellinvia ◽

Maria Pia Amato

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Pediatric Patients ◽

Leisure Activities ◽

Disease Onset ◽

Cognitive Profiles ◽

Brain Growth ◽

Network Activation ◽

Definition Of

Multiple sclerosis (MS) is one of the leading causes of disability in young adults. The onset of MS during developmental age makes pediatric patients particularly susceptible to cognitive impairment, resulting from both disease-related damage and failure of age-expected brain growth. Despite different test batteries and definitions, cognitive impairment has been consistently reported in approximately one-third of pediatric patients with MS. However, the lack of a uniform definition of cognitive impairment and the adoption of different test batteries have led to divergent results in terms of cognitive domains more frequently affected across the cohorts explored. This heterogeneity has hampered large international collaborative studies. Moreover, research aimed at the identification of risk factors (e.g., demographic, clinical, and radiological features) or protective factors (e.g., cognitive reserve, leisure activities) for cognitive decline is still scanty. Mood disorders, such as depression and anxiety, can be detected in these patients alongside cognitive decline or in isolation, and can negatively affect quality of life scores as well as academic performances. By using MRI, cognitive impairment was attributed to damage to specific brain compartments as well as to abnormal network activation patterns. However, multimodal MRI studies are still needed in order to assess the contribution of each MRI metric to cognitive impairment. Importantly, longitudinal studies have recently demonstrated failure of age-expected brain growth and of white matter (WM) and gray matter (GM) maturation plays a relevant role in determining cognitive dysfunction, in addition to MS-related direct damage. Whether these growth retardations might result in specific cognitive profiles according to the age at disease onset has not been studied, yet. A better characterization of cognitive profiles in pediatric MS patients, as well as the definition of neuroanatomical substrates of cognitive impairment and their longitudinal evolution are needed to develop efficient therapeutic strategies against cognitive impairment in this patient population.

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Remote Sensing Applications for Landslide Monitoring and Investigation in Western Canada

Remote Sensing ◽

10.3390/rs13030366 ◽

2021 ◽

Vol 13 (3) ◽

pp. 366

Author(s):

Renato Macciotta ◽

Michael T. Hendry

Keyword(s):

Remote Sensing ◽

Case Studies ◽

Slope Failure ◽

Landslide Monitoring ◽

Western Canada ◽

Extensive Literature ◽

Sensing Applications ◽

Remote Sensing Techniques ◽

Definition Of ◽

River Valleys

Transportation infrastructure in mountainous terrain and through river valleys is exposed to a variety of landslide phenomena. This is particularly the case for highway and railway corridors in Western Canada that connect towns and industries through prairie valleys and the Canadian cordillera. The fluidity of these corridors is important for the economy of the country and the safety of workers, and users of this infrastructure is paramount. Stabilization of all active slopes is financially challenging given the extensive area where landslides are a possibility, and monitoring and minimization of slope failure consequences becomes an attractive risk management strategy. In this regard, remote sensing techniques provide a means for enhancing the monitoring toolbox of the geotechnical engineer. This includes an improved identification of active landslides in large areas, robust complement to in-place instrumentation for enhanced landslide investigation, and an improved definition of landslide extents and deformation mechanisms. This paper builds upon the extensive literature on the application of remote sensing techniques and discusses practical insights gained from a suite of case studies from the authors’ experience in Western Canada. The review of the case studies presents a variety of landslide mechanisms and remote sensing technologies. The aim of the paper is to transfer some of the insights gained through these case studies to the reader.

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Can Vaccination Trigger Autoimmune Disorders? A Meta-Analysis

Vaccines ◽

10.3390/vaccines9080821 ◽

2021 ◽

Vol 9 (8) ◽

pp. 821

Author(s):

Marek Petráš ◽

Ivana Králová Lesná ◽

Jana Dáňová ◽

Alexander M. Čelko

Keyword(s):

Meta Analysis ◽

Autoimmune Disorders ◽

Risk Of Bias ◽

Extensive Literature ◽

Primary Analysis ◽

Measures Of Association ◽

Assessment Development ◽

Extensive Literature Search ◽

The Stability

Vaccination as an important tool in the fight against infections has been suggested as a possible trigger of autoimmunity over the last decades. To confirm or refute this assumption, a Meta-analysis of Autoimmune Disorders Association With Immunization (MADAWI) was conducted. Included in the meta-analysis were a total of 144 studies published in 1968–2019 that were available in six databases and identified by an extensive literature search conducted on 30 November 2019. The risk of bias classification of the studies was performed using the Newcastle–Ottawa Quality Assessment Scale. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. While our primary analysis was conducted in terms of measures of association employed in studies with a low risk of bias, the robustness of the MADAWI outcome was tested using measures independent of each study risk of bias. Additionally, subgroup analyses were performed to determine the stability of the outcome. The pooled association of 0.99 (95% confidence interval, 0.97–1.02), based on a total of 364 published estimates, confirmed an equivalent occurrence of autoimmune disorders in vaccinated and unvaccinated persons. The same level of association reported by studies independently of the risk of bias was supported by a sufficient number of studies, and no serious limitation, inconsistency, indirectness, imprecision, and publication bias. A sensitivity analysis did not reveal any discrepancy in the primary result. Current common vaccination is not the cause of any of the examined autoimmune disorders in the medium and long terms.

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Lipschütz Ulcer: An Unusual Diagnosis that Should Not be Neglected

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1729147 ◽

2021 ◽

Vol 43 (05) ◽

pp. 414-416

Author(s):

Daniela Alexandra Gonçalves Pereira ◽

Eliana Patrícia Pereira Teixeira ◽

Ana Cláudia Martins Lopes ◽

Ricardo José Pina Sarmento ◽

Ana Paula Calado Lopes

Keyword(s):

Emergency Department ◽

Differential Diagnosis ◽

Clinical Course ◽

Malignant Tumors ◽

Sudden Onset ◽

Drug Reactions ◽

Genital Ulceration ◽

Sexually Transmitted ◽

Inflammatory Processes ◽

Genital Ulcers

AbstractThe diagnosis of genital ulcers remains a challenge in clinical practice. Lipschütz ulcer is a non-sexually transmitted rare and, probably, underdiagnosed condition, characterized by the sudden onset of vulvar edema along with painful necrotic ulcerations. Despite its unknown incidence, this seems to be an uncommon entity, with sparse cases reported in the literature. We report the case of an 11-year-old girl who presented at the emergency department with vulvar ulcers. She denied any sexual intercourse. The investigation excluded sexually transmitted infections, so, knowledge of different etiologies of non-venereal ulcers became essential. The differential diagnoses are extensive and include inflammatory processes, drug reactions, trauma, and malignant tumors. Lipschütz ulcer is a diagnosis of exclusion. With the presentation of this case report, the authors aim to describe the etiology, clinical course, and outcomes of this rare disease, to allow differential diagnosis of genital ulceration.

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Sterile pyuria: A differential diagnosis

Comprehensive Therapy ◽

10.1007/s12019-000-0001-1 ◽

2000 ◽

Vol 26 (3) ◽

pp. 150-152 ◽

Cited By ~ 19

Author(s):

Robert S. Dieter

Keyword(s):

Differential Diagnosis ◽

Sterile Pyuria

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Musculoskeletal biomechanics in sit-to-stand and stand-to-sit activities with stroke subjects: a systematic review

Fisioterapia em Movimento ◽

10.1590/s0103-51502010000100004 ◽

2010 ◽

Vol 23 (1) ◽

pp. 35-52 ◽

Cited By ~ 11

Author(s):

Christina Danielli Coelho de Morais Faria ◽

Viviane Amaral Saliba ◽

Luci Fuscaldi Teixeira-Salmela

Keyword(s):

Systematic Review ◽

Methodological Quality ◽

Weight Bearing ◽

Experimental Studies ◽

Quality Parameters ◽

Lower Limbs ◽

Extensive Literature ◽

Manual Search ◽

Sit To Stand ◽

Extensive Literature Search

INTRODUCTION: Sit-to-stand and stand-to-sit are two of the most mechanically demanding activities undertaken in daily life and which are usually impaired in stroke subjects. OBJECTIVES: To determine the distinguishing characteristics in musculoskeletal biomechanical outcomes of the sit-to-stand and stand-to-sit activities with stroke subjects, with an emphasis on the clinical management of stroke disabilities, in a systematic review. MATERIAL AND METHODS: An extensive literature search was performed with the MEDLINE, CINAHL, EMBASE, PEDro, LILACS, and SciELO databases, followed by a manual search, to select studies on musculoskeletal biomechanical outcomes in both activities with stroke subjects, without language restrictions, and published until December/2007. RESULTS: Out of the 432 studies, only 11 reported biomechanical outcomes of both activities and none reached the total score on the selected quality parameters. The majority of the experimental studies which compared groups did not achieve acceptable scores on their methodological quality (PEDRo). The investigated conditions and interventions were also restricted. Only one study compared biomechanical outcomes between the activities, but only evaluated the time spent to perform them. Few musculoskeletal biomechanical outcomes have been investigated, being weight bearing on the lower limbs and duration of the activities the most investigated. CONCLUSION: There is little information regarding musculoskeletal biomechanical outcomes during these activities with stroke subjects and no definite conclusions can be drawn regarding the particularities of these outcomes on their performance with stroke survivors.

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