Update on the approach of urinary tract infection in childhood

AbstractObjectiveUrinary tract infection (UTI) is the most common bacterial infection in childhood. UTI may be the sentinel event for underlying renal abnormality. There are still many controversies regarding proper management of UTI. In this review article, the authors discuss recent recommendations for the diagnosis, treatment, prophylaxis, and imaging of UTI in childhood based on evidence, and when this is lacking, based on expert consensus.SourcesData were obtained after a review of the literature and a search of Pubmed, Embase, Scopus, and Scielo.Summary of the findingsIn the first year of life, UTIs are more common in boys (3.7%) than in girls (2%). Signs and symptoms of UTI are very nonspecific, especially in neonates and during childhood; in many cases, fever is the only symptom.ConclusionsClinical history and physical examination may suggest UTI, but confirmation should be made by urine culture, which must be performed before any antimicrobial agent is given. During childhood, the proper collection of urine is essential to avoid false‐positive results. Prompt diagnosis and initiation of treatment is important to prevent long‐term renal scarring. Febrile infants with UTIs should undergo renal and bladder ultrasonography. Intravenous antibacterial agents are recommended for neonates and young infants. The authors also advise exclusion of obstructive uropathies as soon as possible and later vesicoureteral reflux, if indicated. Prophylaxis should be considered for cases of high susceptibility to UTI and high risk of renal damage.ResumoObjetivoA infecção do trato urinário (ITU) é a infecção bacteriana mais comum na infância. A ITU pode ser o evento sentinela para alteração renal subjacente. Ainda há muitas controvérsias com relação ao tratamento adequado da ITU. Neste artigo de revisão, discutimos as últimas recomendações para diagnóstico, tratamento, profilaxia e imagiologia da ITU na infância, com base em comprovação e, na sua ausência, no consenso de especialistas.Fonte de dadosOs dados foram coletados após uma revisão da literatura e pesquisa no Pubmed, Embase, Scopus e Scielo.Resumo dos dadosNo primeiro ano de vida, as ITUs são mais comuns em meninos (3,7%) do que em meninas (2%). Os sinais e sintomas da ITU são muito inespecíficos, principalmente em neonatos e durante a infância. A febre é o único sintoma em muitos casos.ConclusõesO histórico clínico e exame físico podem sugerir ITU, porém a confirmação deve ser feita por urocultura. Antes da administração de qualquer agente antimicrobiano, deve ser feita coleta de urina. Durante a infância, a coleta de urina adequada é essencial para evitar resultados falso‐positivos. O diagnóstico e o início do tratamento imediatos são importantes na prevenção de cicatriz renal de longo prazo. Neonatos febris com ITUs devem ser submetidos a ultrassonografia renal e da bexiga, Agentes antibacterianos intravenosos são recomendados para neonatos e neonatos jovens. Recomendamos também a exclusão de uropatias obstrutivas o mais rapidamente possível e posterior refluxo vesico‐ureteral, caso indicado. A profilaxia deve ser considerada em casos de elevada susceptibilidade a ITU e risco elevado de danos renais

Angiotensin Converting Enzyme 2, Angiotensin-(1-7), and Receptor Mas Axis in the Kidney

In the past few years the understanding of the renin-angiotensin system (RAS) has improved, helping to better define the role of this system in physiological conditions and in human diseases. Besides Angiotensin (Ang) II, the biological importance of other Ang fragments was progressively evidenced. In this regard, Angiotensin- (Ang-) (1-7) was recognized as a biologically active product of the RAS cascade with a specific receptor, the G-protein-coupled receptor Mas, and that is mainly formed by the action of the angiotensin-converting enzyme (ACE) homolog enzyme, ACE2, which converts Ang II into Ang-(1-7). Taking into account the biological effects of these two mediators, Ang II and Ang-(1-7), the RAS can be envisioned as a dual function system in which the vasoconstrictor/proliferative or vasodilator/antiproliferative actions are primarily driven by the balance between Ang II and Ang-(1-7), respectively. In this paper, we will discuss our current understanding of the ACE2/Ang-(1-7)/Mas axis of the RAS in renal physiology and in the pathogenesis of primary hypertension and chronic kidney disease

A Predictive Model of Postnatal Surgical Intervention in Children With Prenatally Detected Congenital Anomalies of the Kidney and Urinary Tract

The aim of this study was to identify predictive factors and develop a model to assess individualized risk of postnatal surgical intervention in patients with antenatal hydronephrosis. This is a retrospective cohort study of 694 infants with prenatally detected congenital anomalies of kidney and urinary tract with a median follow-up time of 37 months. The main event of interest was postnatal surgical intervention. A predictive model was developed using Cox model with internal validation by bootstrap technique. Of 694 patients, 164 (24%) infants underwent surgical intervention in a median age of 7.8 months. Predictors of the surgical intervention in the model were: baseline glomerular filtration rate, associated hydronephrosis, presence of renal damage and the severity of renal pelvic dilatation. The optimism corrected c statistic for the model was 0.84 (95%CI, 0.82–0.87). The predictive model may contribute to identify infants at high risk for surgical intervention. Further studies are necessary to validate the model in patients from other settings

Pediatric Patients With Steroid-Sensitive Nephrotic Syndrome Have Higher Expression of T Regulatory Lymphocytes in Comparison to Steroid-Resistant Disease

Background and Aim: Idiopathic nephrotic syndrome (INS) is classified according to the response to drug therapy in steroid-sensitive (SS), steroid-dependent (SD), and steroid-resistant (SR) categories. Previous studies showed changes in inflammatory activity of subpopulations of lymphocytes in INS. This study aimed to compare SS and SR patients in regard to subpopulations of leukocytes, profile of regulatory lymphocytes, and migratory activity of lymphocyte subpopulations. Results obtained in INS patients were also compared to age and sex-matched healthy controls.Methods: This is a cross-sectional study including SS patients (n = 30), SR patients (n = 14), and controls (n = 10). Peripheral blood samples were withdrawn for ex-vivo leukocyte flow cytometry analysis.Results: Percentage of B-lymphocytes and natural killer (NK) cells were significantly reduced in SR patients when compared to controls, while the percentage of NKT cells were decreased in SS patients in comparison to controls. Percentages of CD4+ expressing FoxP3 and CTLA4 were significantly higher in SS patients in comparison to SR patients and controls. The expression of integrin CD18 on the surface of T lymphocytes (CD3+) was reduced in SS patients if compared to controls.Conclusion: This study found that SS INS patients have higher levels of regulatory T-lymphocytes and lower expression of adhesion molecules than SR patients

How the COVID-19 pandemic has affected children and adolescents’ sleep habits: a systematic review

Introduction: Sleep is a multimodal construct related to the quality of life of children and adolescents. Therefore, sleep problems might affect attention, internalizing and externalizing behaviors. During the pandemic, children were pointed as a risk group for sleep problems compared to other age groups. Objective: We aimed to conduct a systematic search in the literature, in order to investigate the effects of the COVID-19 pandemic on sleep habits in children and adolescents, addressing changes on sleep duration, bedtime and wake-up time, risk and protective factors, and the particularities of children and adolescents with neurodevelopmental disorders. Methods: The search was conducted in PubMed, Scopus, and Cochrane Library databases. After the full reading evaluation a total of 133 articles, comprising 234,852 participants from 45 countries, met inclusion criteria. Results: An increase in week sleep hours and delay in sleep and wake-up time were observed as well as a worse quality of sleep. Among the emerging risk factors were evaluated confinement, age, gender, previous diagnosis, screen use, and physical activities. For children with neurodevelopmental disorders, heterogeneity in methodology and sampling constraints do not allow generalizations. Conclusion: The most important problem in children and adolescents about sleep during the pandemic was not the number of hours, but the increase in disorders related to sleep and to changes in sleep rhythm. The understanding of sleep changes might shed light on long-term effects and consequences related to the pandemic and the relationship with stress and disorders, which deserves attention to rethink the youths' routines

Modelling the distribution of a commercial NE-Atlantic sea cucumber, Holothuria mammata : demographic and abundance spatio-temporal patterns

Funding: This study was financed by the Operational Programme Mar2020, MAR-02.01.01-FEAMP-0052, “Newcumber – Avanços para o cultivo sustentável de pepinos do mar”. It received further financial support from Fundação para a Ciência e Tecnologia (projects UIDB/04292/2020, UIDB/00006/2020, CoastNet – PINFRA/22128/2016, AB with the Scientific Stimulus Programme – CEECIND/00095/2017 and FA with the individual research grant 2020.09563.BD). This publication was financed by Portuguese national funds through FCT – Fundação IP under project reference UIDB/04292/2020, and by the European Union’s Horizon 2020 Research and Innovation Program under grant agreement N810139: Project Portugal Twinning for Innovation and Excellence in Marine Science and Earth Observation – PORTWIMS.There is an increasing demand for sea cucumbers, for human consumption, mainly from Asian markets and, as a consequence, NE-Atlantic species are now new targets for exploitation and exportation. Holothuria mammata is one of the most valuable species in Europe. However, the lack of historical economic interest in this species in most European countries has also led to a lack of studies concerning biological and ecological aspects on wild populations and this is a major issue for stock management. This study aims to determine the temporal and spatial patterns of distribution of H. mammata, considering its abundance and demographic structure in a NE-Atlantic area, SW Portugal, as a function of environmental conditions. For that, a population from a marine protected area was followed for 1 year at 1.5-month intervals. Throughout the coastal area, six sites were selected and at each sampling campaign three random transects per site and substrate (rock and sand) in which all H. mammata individuals were counted and measured. For each site and survey several environmental parameters of interest, from the water column, the sediment and substrate cover, were also measured. Generalized Linear Models were used to model the spatial and temporal distribution of the species according to environmental conditions, to determine the species’ habitat preferences. The distribution models indicate that abiotic and biotic parameters of the water column are not the main drivers shaping the distribution of H. mammata. The species has a patchy distribution, and its habitat preferences depend on environmental stability, the presence of shelter and habitat complexity, which is more important for smaller, more vulnerable, individuals, while bigger size classes tend to venture more into less stable environments in an opportunistic fashion. The knowledge of these population traits is determinant to develop stock management measures, which are now urgent to prevent the depletion of commercial sea cucumber populations in the NE-Atlantic. Sustainable fisheries policies should be developed and start by considering to delimit fishing areas and periods, considering the species spatial and temporal distribution patterns.Publisher PDFPeer reviewe

Nutritional evaluation of children with chronic cholestatic disease

AbstractObjectiveTo evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice.MethodsChildren with persistent cholestasis, i.e increased direct bilirrubin or changes in the canalicular enzyme gamma‐glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI).ResultsNinety‐one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below –2 Z‐scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below –2 Z‐scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index.ConclusionEvaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.ResumoObjetivoAvaliar a situação nutricional de crianças com colestase persistente e comparar os índices antropométricos entre crianças com e sem cirrose hepática e crianças com e sem icterícia.MétodosForam incluídas crianças com colestase persistente, ou seja, aumento da bilirrubina direta ou alterações na enzima canalicular, gamaglutamiltransferase (GGT). As medidas antropométricas foram peso, estatura ou altura, circunferência do braço (CB), espessura da prega cutânea do tríceps (TST), circunferência muscular do braço (CMB) e índice de massa corporal (IMC).ResultadosForam avaliadas 91 crianças com colestase, com idade média de 12 meses; 33% e 30,8% dos pacientes apresentaram índices P/I e A/I com escore Z abaixo de –2, respectivamente. Com relação ao índice P/A e IMC, somente 12% e 16% dos pacientes, respectivamente, apresentaram escore Z abaixo de –2. Com relação à CB, 43,8% de 89 pacientes avaliados apresentaram alguma depleção. Observando a TST, 64% dos pacientes que apresentaram depleção, 71,1% dos 45 pacientes avaliados apresentaram algum grau de depleção com relação ao índice de CMB.ConclusãoA avaliação do peso em pacientes com doenças hepáticas crônicas poderá superestimar a situação nutricional devido a visceromegalia, edema subclínico ou ascite. Os índices que correlacionam peso e altura, como P/A e IMC, também podem não mostrar depleção devido à doença crônica em que há depleção tanto do peso quanto da altura. A TST, BC e CMB são parâmetros que estimam melhor a situação nutricional e devem fazer parte de gestão de pacientes com doenças hepáticas e colestase