scholarly journals Antenatal hydronephrosis: a five-year retrospective study

2021 ◽  
Vol 35 (3) ◽  
Author(s):  
Maria Gaia ◽  
◽  
Mariana Capela ◽  
Margarida Peixoto ◽  
Joana Borges ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Kidney Injury ◽  
Risk Groups ◽  
Mean Value ◽  
Third Trimester ◽  
Antenatal Hydronephrosis ◽  
Male Predominance ◽  
Wide Range ◽  
Definition Of

Introduction: Antenatal hydronephrosis (ANH) is common in fetal ultrasounds. Though mostly transient, it can be associated with congenital abnormalities and kidney injury. The authors went to assess the evolution of children with ANH and identify risk groups. Methods: Retrospective cohort study of children with ANH from 2013‑2017. Renal pelvis anteroposterior diameter (APD) of 4 and 7mm or more in the second and third trimester, respectively, defined diagnosis of ANH. APD also defined severity stratification. The primary out‑ comes included occurrence of urinary tract infection (UTI) and congenital anomalies of the kidney and urinary tract (CAKUT). Results: We identified 198 cases, with male predominance (76.8%) and a 2.1% incidence. It resolved antenatally in 12.1%, with a lower mean value of APD in these cases (p=0.017), and persisted in 43.4%. CAKUT were found in 8.6% of the patients. At least 1 episode of UTI occurred in 9.1% of patients during follow‑up. The degree of ANH in the 3rd trimester was related to postnatal persistence and degree (p<0.001) and the postnatal degree was related to the occurrence of UTI (p=0.008). The 3rd trimester and postnatal degree were also associated to the presence of CAKUT (p=0.036; p=0.001), although not with vesicoureteral reflux (VUR). The persistence of ANH through the 2nd and 3rd trimester was related to postnatal persistence (p=0.002) and degree (p=0.007), and the presence of CAKUT excluding VUR (p=0.034). The optimal cut‑off for the APD in the 3rd trimester to predict the occurrence of negative outcomes (CAKUT and/or UTI), through a receiver operating characteristic (ROC) curve, was 8.225mm with 76% sensitivity and 59% specificity. Discussion: ANH is frequent and reflects a wide range of conditions, requiring follow‑up. Most cases resolve spontaneously and require no further intervention other than ultrasounds. 3rd trimester and postnatal degree are related to prognosis, allowing the definition of risk groups and the improvement of patient management.

scholarly journals A study on postnatal evaluation and follow-up of infants with antenatally detected hydronephrosis

2017 ◽  
Vol 4 (5) ◽  
pp. 1677
Author(s):  
Soundaiyan Balasankar ◽  
Jeyaraman Balasubramanian
Keyword(s):  
Urinary Tract ◽  
Surgical Intervention ◽  
P Value ◽  
Postnatal Life ◽  
Antenatal Hydronephrosis ◽  
Urinary Tract Anomaly ◽  
Antenatal Ultrasonography ◽  
Significant Pathology ◽  
Anteroposterior Renal Pelvic Diameter

Background: Antenatal hydronephrosis(ANH) has now become a frequent diagnosis with the increasing use of antenatal ultrasonography. Objective of present study was to evaluate and follow up infants with antenatally detected hydronephrosis and to determine whether there is significant correlation between anteroposterior renal pelvic diameter detected in antenatal USG and urinary tract anomalies detected postnatally.Methods: After obtaining an informed consent, all neonates with antenatal ultrasound showing hydronephrosis (n=80) were enrolled in the study. Postnatal ultrasound was done at 3 days ,1 month and 6 months of postnatal life. Atleast 6 months followup was done to look for spontaneous resolution or other significant pathology. Micturating cystourethrography/radionuclide scan done in selected cases.Results: Out of 80 cases ,43 had mild,24 had moderate and 13 had severe degrees of hydronephrosis.31 of them (9 mild,10 moderate and 12 with severe hydronephrosis) had postnatal anomaly detected.14 of them (1 mild, 4 moderate and 9 with severe hydronephrosis) underwent surgery. As the grade of antenatal hydronephrosis increases from mild, moderate to severe, the relative risk of postnatal anomaly and requirement of surgical intervention also increased (p value<0.0001).Conclusions: Antenatal hydronephrosis may be associated with significant postnatal urinary tract anomaly with risk quantified by the measurement of anteroposterior renal pelvic diameter(APPD). 

scholarly journals Clinicoetiological profile of urinary tract infection in pediatric population in a teaching hospital in south India

2021 ◽  
Vol 8 (12) ◽  
pp. 1958
Author(s):  
Poornima Venugopal ◽  
Carol Sara Cherian ◽  
Pooja Raghunath
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Teaching Hospital ◽  
Bacterial Infections ◽  
Clinical Presentation ◽  
Diffusion Method ◽  
Male Predominance ◽  
Causative Microorganism ◽  
Wide Range

Background: Urinary tract infection (UTI) is one of the most common bacterial infections seen in children. A wide range of organisms with varying antibiotic sensitivity patterns have been known to cause UTI. The objective of the study was to analyse the clinical presentation of UTI in children between 1-month to15 years of age and to analyse the causative microorganism and their drug susceptibility in UTI in children between 1 month to 15 years of age.Methods: A retrospective study was conducted in a teaching hospital in Kerala, between July 2018 and June 2020 among children 1 month to 15 years of age who presented with symptoms of UTI. Patients who had culture positive UTI were included in the study. Clinical data was obtained from inpatient and outpatient records. Antimicrobial susceptibility was done for positive urine culture by Kirby-Bauer disk diffusion method. Statistical analysis was done using Statistical package for social sciences (SPSS) software version 16.Results: Of the 1057 urine samples analysed, 18.44% had significant bacteuria. 43.07% were children less than one year of age with male predominance. Fever and dysuria were the most common clinical presentation. E. coli was the most prevalent pathogen isolated followed by Klebsiella pneumoniae. Enterococcus faecalis was the only gram-positive bacilli isolated. Highest resistance was shown to ampicillin, third generation cephalosporins and co-trimoxazole. Least resistance was shown to nitrofurantoin, fluoroquinolones, aminoglycosides, piperacillin- tazobactam and carbapenems.Conclusions: Regular surveillance programme is necessary for implementation of guidelines for empiric treatment of UTI.

scholarly journals Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253696
Author(s):  
Jia Li ◽  
Gyorgy Simon ◽  
M. Regina Castro ◽  
Vipin Kumar ◽  
Michael S. Steinbach ◽  
...  
Keyword(s):  
Body Mass ◽  
Mortality Risk ◽  
Risk Model ◽  
Risk Groups ◽  
Baseline Risk ◽  
Increased Risk ◽  
Wide Range ◽  
Baseline Mortality ◽  
All Cause Mortality

Objective The association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk. Methods Retrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2. Results Of 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups. Conclusions There is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.

scholarly journals Fetal Cholelithiasis: A Diagnostic Update and a Literature Review

2013 ◽  
Vol 6 ◽  
pp. CCRep.S12273 ◽  
Author(s):  
Stefania Triunfo ◽  
Paolo Rosati ◽  
Pietro Ferrara ◽  
Antonio Gatto ◽  
Giovanni Scambia
Keyword(s):  
Literature Review ◽  
Clinical Significance ◽  
Diagnostic Approach ◽  
Postnatal Life ◽  
Third Trimester ◽  
3 Dimensional ◽  
Definition Of

Fetal gallstones and cholelithiasis, detected by routine third trimester ultrasound, have been described in the literature with controversial clinical significance. We report a case of fetal cholelithiasis detected at 35 weeks gestation during a routine scan. The diagnosis was performed using an integrated 2-dimensional (2-D) and 3-dimensional (3-D) ultrasound approach in order to obtain a better definition of the fetal gallbladder and its content. A neonatal follow-up was achieved. The present study has a twofold purpose: firstly, to update the diagnostic approach using the innovative 3-D modalities and secondly, to review the management of this condition during fetal and postnatal life.

scholarly journals Postnatal evaluation of intrauterine hydronephrosis due to ureteropelvic junction obstruction

2013 ◽  
Vol 28 (suppl 1) ◽  
pp. 33-36 ◽  
Author(s):  
Carlos Augusto Fernandes Molina ◽  
Inalda Facincani ◽  
Valdair Francisco Muglia ◽  
Whemberton Martins de Araujo ◽  
Marcelo Ferreira Cassini ◽  
...  
Keyword(s):  
Renal Function ◽  
Surgical Treatment ◽  
Surgical Approach ◽  
Urinary Tract Obstruction ◽  
Ureteropelvic Junction ◽  
Fetal Hydronephrosis ◽  
Antenatal Hydronephrosis ◽  
Upj Obstruction ◽  
Definition Of

PURPOSE: Fetal hydronephrosis is a frequent finding due to advances in prenatal ultrasonography. The definition of fetal and neonatal urinary tract obstruction is a very difficult task requiring confirmation of reduced renal function and hydronephrosis. In this study we followed a series of consecutive patients with intrauterine hydronephrosis that persisted during post-natal life. METHODS: 116 newborns with antenatal hydronephrosis diagnosed by ultrasound and submitted to a specific post-natal evaluative protocol with a follow-up period of 6 years. RESULTS: In 45 (38.8%) of 116 patients, ureteropelvic junction (UPJ) obstruction was confirmed and surgical correction of the UPJ obstruction was done in 19 patients. From 26 children who were initially submitted to non-surgical treatment, only 6 (23%) needed a surgical approach during follow up. Overall analysis showed that surgery was performed in 25 patients with UPJ obstruction, and the others 20 patients were kept under clinical observation, since normal renal function was confirmed by scintigraphy scans. CONCLUSION: Fetal hydronephrosis due to UPJ obstruction deserves careful postnatal evaluation. UPJ obstruction is the most frequent anomaly and its surgical treatment has very precise indications. The evaluative protocol was useful in identify patients that could be followed-up with a non-surgical approach.

A New Molecular and Clinical Prognostic Score for Risk Stratification in CN-AML.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2635-2635
Author(s):  
Friederike Schneider ◽  
Annika Dufour ◽  
Tobias Benthaus ◽  
Stephanie Schneider ◽  
Gudrun Mellert ◽  
...  
Keyword(s):  
Platelet Count ◽  
De Novo ◽  
Prognostic Score ◽  
Performance Status ◽  
Risk Groups ◽  
Wild Type ◽  
Free Survival ◽  
De Novo Aml ◽  
Definition Of

Abstract Abstract 2635 Poster Board II-611 Background: Cytogenetically normal acute myeloid leukemia (CN-AML) is associated with an intermediate outcome. A number of clinical and molecular risk factors have been characterized pointing to the heterogeneity of this group. The purpose of the study was to define a prognostic model based on pre-treatment patient characteristics to facilitate choice of therapy by definition of patient groups with different prognoses. Patients and methods: We evaluated four molecular markers (mutations of NPM1, CEBPA, MLL-PTD; FLT3-ITD mutant level; interaction term NPM1 and FLT3-ITD mutant level) and nine clinical parameters (white blood count (WBC), platelet count, hemoglobin level, lactase dehydrogenase (LDH) level, bone marrow blasts, de novo AML vs. non de novo AML, performance status, sex and age) at initial diagnosis in 648 patients with CN-AML treated in the AMLCG (German AML Cooperative Group) 1999 trial. The outcome parameter overall survival (OS) was calculated from randomization to death from any cause or to the latest follow-up date. Event-free survival (EFS) was defined as the period from the start of therapy until lack of a complete remission (CR), relapse of AML after CR or death without relapse. Relapse-free survival (RFS) was determined for responders from the first day of a CR until relapse or death without relapse. Univariate and multivariate Cox regression analyses for OS were performed. All parameters with p'0.05 in multivariate analyses after backward elimination and their regression coefficients were applied in the prognostic score. The minimal p-value approach was used to identify the risk groups with the greatest differences in OS. Results: In our patient cohort 84% had de novo AML. Median age was 60 years (17–85 years) and 70% had an ECOG score ≤1. Median platelet count was 57 G/l (5–643 G/l), median WBC was 18 G/l (0.1–798 G/l) and median hemoglobin level was 9.2 g/dl (4.2–16.4 g/dl). Mutations of NPM1, FLT3-ITD, MLL-PTD and CEBPA were present in 51%, 27%, 8% and 10% of patients, respectively. Median FLT3-ITD mutant level in FLT3-ITD mutated patients was 0.42 (0.02–1.00). Of 648 patients 377 had died. Median OS was 20 months with a median follow-up of 45 months. In the multivariate analyses for OS, the following parameters were significant: age (+10, years, HR: 1.3, p<0.001), WBC (10 fold, ×109/l, HR: 1.4, p<0.001), NPM1 (mutation vs. wild-type, HR: 0.35, p<0.001), CEBPA (mutation vs. wild-type, HR: 0.47, p=0.001), interaction term NPM1/FLT3-ITD mutant level (+1, HR: 4.5, p=0.006), performance status (ECOG 0,1 vs. ECOG 2-4, HR: 1.4, p=0.006) and platelet count (10 fold, ×109/l, HR: 0.70, p=0.016). After calculation of the prognostic score for each patient and definition of two cutpoints, we could identify three risk groups (median OS (N=590): not reached (n=169) vs. 22.7 months (n=220) vs. 8.4 months (n=201), p<0.001; median EFS (N=583): 42.3 months (n=168) vs. 7.6 months (n=216) vs. 3.2 months (n=199), p<0.001; median RFS (N=383): not reached (n=136) vs. 15.3 months (n=143) vs. 7.6 months (n=104), p<0.001). Furthermore this model was valid in both age subgroups (<60 years / ≥60 years). Interestingly, a subset of 31% of patients within the molecular favorable NPM1+/FLT3-ITD- risk group were assigned to the intermediate group according to our prognostic score and 31% of the low risk group were not NPM1+/FLT3-ITD-. Conclusions: We propose a new prognostic score based on pre-therapeutic clinical and well-established molecular markers that could be easily applied in the routine patient care setting for risk stratification and risk-adapted therapy. Further prospective validation is required to confirm the clinical relevance of this score. Disclosures: Unterhalt: Roche: travel support. Hoster:Roche: travel support.

scholarly journals Exacerbation of Congenital Hydronephrosis as the First Presentation of COVID-19 Infection in Children: A Case Series

2021 ◽  
Author(s):  
Masoumeh Mohkam ◽  
Mahnaz Jamee ◽  
Farshid Kompani ◽  
Mitra Khalili ◽  
Atena Seifi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Case Series ◽  
Upper Urinary Tract ◽  
Abrupt Increase ◽  
Antenatal Hydronephrosis ◽  
Congenital Hydronephrosis ◽  
Abdominal Masses ◽  
The Common ◽  
Case Presentations

Abstract Background:Congenital hydronephrosis is one of the most common abnormalities of the upper urinary tract, which can be exacerbated by a variety of intrinsic or extrinsic triggers. The urinary tract system is one of the major organs complicated by COVID-19 infection. Case presentations:Here we report five patients with an established diagnosis of congenital hydronephrosis, who presented with acute abdominal pain and fever and an abrupt increase in the anteroposterior pelvic diameter (APD). Patients had a previous stable course and were under regular follow-up with serial ultra-sonographic studies. They underwent surgery or supportive treatment due to the later exacerbation of hydronephrosis. Based on the clinical and imaging findings, no plausible etiologies for these exacerbation episodes, including infection, nephrolithiasis or abdominal masses, could be postulated. The common aspect in all these patients was the evidence of a COVID-19 infection. Conclusions:Infection with COVID-19 in children with antenatal hydronephrosis may exacerbate the degree of hydronephrosis and renal APD in ultrasonography, which itself may be mediated by the increase in inflammatory mediators.

scholarly journals Adrenal adenomas: what to do with them? Review 2

2021 ◽  
Vol 17 (3) ◽  
pp. 241-249
Author(s):  
S. Rybakov
Keyword(s):  
Malignant Tumors ◽  
Optimal Operation ◽  
Gross Error ◽  
Wide Range ◽  
Morphological Diagnosis ◽  
The Subject ◽  
Definition Of ◽  
Significant Size ◽  
Initial Results

Adrenal incidentalomas (AI) are a collective, working category that contains a wide range of different forms of patho­logy of these glands. They differ in the original tissue structures from which they originate, in clinical and hormonal characte­ristics, in diagnostic and tactical approaches. Such a wide range of emergencies, which are hidden under the guise of accidentally detected AI, puts before the clinician the task of identifying them (establishing a clinical and, if possible, morphological diagnosis) with the definition of tactical approaches. Based on the analysis of these data, as well as numerous publications, their working classification is proposed. When deciding on surgical treatment, the surgeon must have a clinical diagnosis — what nosological form of adrenal pathology is to be operated on. Interventions with the diagnosis AI are unacceptable and are a gross error. The optimal operation for most such tumors is laparoscopic adrenalectomy with the tumor. Open operations are indicated for malignant tumors of significant size, especially with signs of invasion into surrounding structures. Given that most AI are benign formations, it is equally important to determine further tactics for them — the mode and duration of observation, the order and scope of control clinical and hormonal and imaging studies, the principles of evaluation of the results. Several guidelines indicate that in the presence of hormonally inactive adenomas, without signs of malignancy, less than 3–4 cm in size, no further observation is indicated. It is noted that in such tumors the tendency to growth, malignancy, emergence of hormonal activity is extremely seldom observed. In other cases, especially with the slightest doubt of the initial results, follow-up examinations are recommended after 3, 6, 12 months and then after 1–2 years, the maxi­mum period is set to five years. These parameters are the subject of discussion in various clinics.

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

2019 ◽  
Vol 58 (05) ◽  
pp. 371-378
Author(s):  
Alfred O. Ankrah ◽  
Ismaheel O. Lawal ◽  
Tebatso M.G. Boshomane ◽  
Hans C. Klein ◽  
Thomas Ebenhan ◽  
...  
Keyword(s):  
Tracer Uptake ◽  
Pet Ct ◽  
The Mean ◽  
18F Fdg ◽  
Definition Of ◽  
Gallium 68 ◽  
Attending Physician ◽  
Pet Scans ◽  
The Brain

Abstract 18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001). Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

Risk Factors in Diabetes and Pregnant Women with Urinary Tract Infections Compared to Younger Aged Female.

2018 ◽  
Vol 1 (3) ◽  
pp. 26-38
Author(s):  
Abdulghani Mohamed Alsamarai ◽  
Shler Ali Khorshed
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pregnant Women ◽  
Female Student ◽  
Mean Value ◽  
Infected Female ◽  
Significant Difference ◽  
Tract Infections

Background: Urinary tract infection is common with health impact in women and characterised by failure to treatment and recurrent episodes. Aim: This study was conducted to determine the risk factors for the development of urinary tract infection in diabetic and pregnant women in comparison to student female. Materials and methods: A prospective cross-sectional study conducted during the period from 1st of June 2015 to the end of January 2016. The population included in the study are 563 women, of them 425 were outpatients, and 138 were inpatients. Their age range between 18 and 80 years, with a mean age of 33.59±15.29 years. Urine samples collected and cultured on blood agar and MacConkey agar by spread plate technique. Bacterial colonies with different morphology were selected, purified and identified according to their biochemical characteristics using conventional standard methods. Results: In diabetic women, there were no significant difference in mean age and BMI values between culture positive and culture negative groups. However, pus cell mean scale was significantly higher [P=0.000] in women with urinary tract infection [1.76±1.25] than in those with negative culture [0.69±1.00]. In pregnant women, BMI mean value was significantly [P=0.013] lower in pregnant women with UTI [26.14] as compared to those without infection [26.99]. Pus cell scale mean value was significantly [P=0.000] higher in pregnant women with UTI [1.55] than women with negative UTI [0.85]. While there was no significant difference in mean age between UTI positive and negative pregnant women. In female student, there was a significant difference between UTI infected and non-infected in mean age [P=0.041] and pus cell scale [P=0.000]. However, BMI was not significantly different between infected and non-infected female student. Other risk factors association are variables in the 3 groups when analysed using X2, while AUC and OR show different trends of association between risk factors and UTI. Conclusion: BMI, pus cell scale, child number, delivery method, operation history and hospital setting were significantly associated with culture positivity in the 3 studied groups as determined by AUC. While OR confirmed association with pus sale scale in the 3 groups.

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