Comparison between diuretic urography (IVP) and diuretic renography for diagnosis of ureteropelvic junction obstruction in children

Background: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of urinary tract obstruction in children. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography (US), intravenous pyelogram (IVP), diuretic renography (DR), magnetic resonance urography (MRU) and antegrade or retrograde pyelography. Nowadays it is suggested to use diuretic renography as the best method for diagnosing of UPJO. There is no comparative study between IVP and DR scan for diagnosis of UPJO in children. Objectives: The aim of the present study was to compare IVP with furosemide injection and diuretic renography in diagnosis of clinically significant UPJO. Patients and Methods: This was a cross sectional study performed in 153 UPJO suspected children (121 boys, 32 girls) based on US findings in cases presented with urinary tract infection (UTI), prenatal hydronephrosis, abdominal/flank pain, abdominal mass and hematuria. Renal ultrasound was used as an initial screening tool for detection of urinary tract abnormality. Vesicoureteral reflux (VUR) was ruled out by voiding cystourethrography (VCUG). Serum creatinin, blood urea nitrogen, urinalysis and urine culture was screened in all cases. IVP with furosemide and DR were performed as soon as possible after the mentioned workup. Results: During a five year period, 46 out of 153 patients were diagnosed as UPJO based on diuretic renography: the age ranged from 4 months to 13 years (mean: 3.1 ± 0.78 years). There was a significant higher (76) proportion of UPJO in the boys and in the left side (78). The sensitivity of IVP with furosemide injection in diagnosis of UPJO was 91.3 whereas DR was accepted as standard for diagnostic procedure in diagnosis of UPJO. Conclusions: Although DR is accepted as the best method for diagnosis of UPJO, we found a small sensitivity difference between IVP and DR in kidneys with normal or near normal function. In many settings such as small cities lacking facilities for advanced isotope imaging technology, use of IVP with diuretic maybe an acceptable procedure for diagnosis of UPJO. © 2016, Growth & Development Research Center

Cecal duplication cyst complicated by prolapsed ileocolic intussusception

Cecal duplication cysts are very rare including 0.4 of all GI tract duplications. The ultrasound (US) is the imaging of choice for duplication cysts detection in pediatrics. Cyst's wall is made up of an inner mucosal layer, which is echogenic and an outer muscular layer, which is hypoechoic at US (called �pseudo kidney� appearance on longitudinal view or �doughnut� appearance on transverse view). Intussusception is one of the duplication cyst's complications. Intussusception presented with trans-anal protrusion (prolapsed intussusception) is a rare and confusing condition which can cause delayed diagnosis and further complications. We present an 18-month old boy with Cecal duplication cyst causing intussusception, which protruded from anus. © 2020 The Author

Coronavirus disease 2019 (COVID-19) outbreak in pediatrics and the role of pediatricians: A systematic review

The coronavirus disease 2019 (COVID-19) outbreak initiated in Wuhan, China and has spread rapidly all around the world and labeled as a pandemic with almost 168,000 infected cases and 6,500 deaths globally up to March 16, 2020. It is believed that children are less likely than adults to be infected with COVID-19. In this review, we discuss different aspects of COVID-19 infection in pediatrics. COVID-19 in pediatrics occurs in the early stages of its outbreak at a high rate with a family cluster pattern mainly. Children infected with COVID-19 are mostly asymptomatic carriers and the main potential causes of the spread and transmission of the disease in com-munities. Asymptomatic children with no underlying disease or red flags should follow home isolation protocols. Children with red flags, comorbidities and risk factors or those with severe pneumonia must be admitted to the hospitals. Children�s hospitals should be equipped with the acute respiratory diseases ward, quarantine rooms, and intensive care unit to protect other patients and health care staff during the COVID-19 outbreak. © 2020, Author(s)