RESUMO
OBJECTIVE: To identify factors associated with overtreatment of presumed urinary tract infection (UTI) among children with spina bifida using such criteria. STUDY DESIGN: A retrospective review of children with spina bifida (age <21 years) evaluated in the Emergency Department (ED) at a single institution was performed. Patients with a urinalysis (UA) performed who were reliant on assisted bladder emptying were included. The primary outcome was overtreatment, defined as receiving antibiotics for presumed UTI but ultimately not meeting spina bifida UTI criteria (≥2 urologic symptoms plus pyuria and urine culture growing >100k CFU/mL). The primary exposure was whether the components of the criteria available at the time of the ED visit (≥2 urologic symptoms plus pyuria) were met when antibiotics were initiated. RESULTS: Among 236 ED encounters, overtreatment occurred in 80% of cases in which antibiotics were initiated (47% of the entire cohort). Pyuria with <2 urologic symptoms was the most important factor associated with overtreatment (OR 9.6). Non-Hispanic White race was associated with decreased odds of overtreatment (OR 0.3). CONCLUSIONS: Overtreatment of presumed UTI among patients with spina bifida was common. Pyuria, which is not specific to UTI in this population, was the main driver of overtreatment. Symptoms are a cornerstone of UTI diagnosis among children with spina bifida, should be collected in a standardized manner, and considered in a decision to treat.
Assuntos
Antibacterianos , Sobretratamento , Disrafismo Espinal , Infecções Urinárias , Humanos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/diagnóstico , Infecções Urinárias/complicações , Disrafismo Espinal/complicações , Estudos Retrospectivos , Feminino , Antibacterianos/uso terapêutico , Masculino , Criança , Pré-Escolar , Adolescente , Lactente , Serviço Hospitalar de Emergência , UrináliseRESUMO
OBJECTIVE: To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis. STUDY DESIGN: We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes. RESULTS: Urinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis. CONCLUSIONS: Immune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.
Assuntos
Infecções Bacterianas , Cistite/microbiologia , Pielonefrite/microbiologia , Infecções Urinárias , Doença Aguda , Infecções Bacterianas/sangue , Infecções Bacterianas/urina , Biomarcadores/análise , Pré-Escolar , Cistite/sangue , Cistite/diagnóstico , Cistite/urina , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Projetos Piloto , Estudos Prospectivos , Pielonefrite/sangue , Pielonefrite/induzido quimicamente , Pielonefrite/urina , Infecções Urinárias/sangue , Infecções Urinárias/urinaRESUMO
We identified factors associated with delay in presentation and misdiagnosis of testicular torsion. Compared with acute cases, delayed presentations were more likely to report isolated abdominal pain, developmental disorders, and history of recent genital trauma. Failure to perform a genitourinary examination or scrotal imaging was associated with misdiagnosis.
Assuntos
Diagnóstico Tardio , Erros de Diagnóstico , Torção do Cordão Espermático/complicações , Torção do Cordão Espermático/diagnóstico , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Torção do Cordão Espermático/terapiaRESUMO
An adult male of a newly discovered strepsipteran species from Brazil-Bahiaxenos relictus-is described. A new family Bahiaxenidae is suggested based on cladistic analyses of comprehensive morphological data sets with a broad taxon sampling including the stem group. It is unambiguously placed as the sister group of all other extant families of Strepsiptera. Bahiaxenos relictus is the only species of basal, i.e. non-stylopidian, Strepsiptera occurring in the New World. It appears to be a relict taxon that has survived in the fossil sand dunes of the São Francisco River (Bahia State). The loss of the 8th antennomere and the greatly reduced labrum are autapomorphies of Strepsiptera s.s. excluding Bahiaxenidae. The sister group relationship betweenProtoxenidae and the remaining Strepsiptera, and between Cretostylops and a clade comprising Mengea and Strepsiptera s.s., is confirmed, as is the monophyly of Stylopidia and Stylopiformia.
RESUMO
O presente artigo tem como objetivo explorar a qualidade de vida de jovens portadores de espinha bífida atendidos no Children's National Medical Center em Washington DC. A pesquisa baseia-se em uma perspectiva qualitativa que utiliza como referencial teórico central a "Teoria do estigma" e as discussões conceituais sobre as dimensões de qualidade de vida. Foram entrevistados 15 jovens do serviço acima citado, sendo que 8 deles participaram de um grupo focal construído através das questões levantadas durante entrevistas. Os discursos dos jovens em questão refletem a necessidade de categorias mais englobantes que não remetam a uma pulverização da experiência de vida. Evidenciou-se uma estrutura de desigualdade nas interações entre saudáveis e deficientes, e reproduzida pelos próprios jovens. Os resultados demonstram que o estigma se encontra presente em todas as dimensões da vida dos sujeitos, interferindo na inserção social, construção subjetiva do jovem e sua auto-estima, reforçando o papel do portador de deficiência como uma "não-pessoa". Embora a categoria sexualidade não seja priorizada em outros instrumentos para esta população, o tema se faz presente e central na discussão da experiência da vida dos mesmos.
The present article explores the quality of life of adolescents with spina bifida at the Children's National Medical Center in Washington DC. The research is based on a qualitative perspective that utilizes the "Theory of stigma" as the central theoretical framework, in addition to the discussions of the concept of quality of life and its dimensions. Fifteen adolescents were interviewed at the above institution, eight of which then participated in a focal group structured through issues that emerged during this previous phase. The discourses reflected the need for more encompassing categories for quality of life that do not pulverize the life experience. The adolescent's discourses demonstrate an inequality structure in interactions between the healthy and the disabled. The results demonstrated that stigma permeates all life dimensions of these subjects, interfering in their social inclusion, as well as in their subjective construction and self-esteem, asserting the role of the disabled as a "non-person". Finaly, we found that even though sexuality was not prioritized in other instruments that contemplate this population, the theme emerges as central to the discussion of their life experiences.