Urodynamic Study in Children

A b s t r a c t:Urodynamic study (UDS) is a serial of clinical tests, like uroflowmetry, filling cystometry, pressure-flow studies and assessment of urethral closure pressure. These tests include urethral pressure profilometry and also measurement of the leak-point pressure of lower urinary system. UDS is one of the essential clinical studies in children complaining of voiding dysfunction, neurogenic bladder, urine incontinence, enuresis and another lower urinary tract symptom. The aim of proper bladder management in these patients is to maintain the lower urinary tract to have good capacity, low pressure, preventing infection and incontinence. Long term goal is preventing any undue damage to the upper urinary tracts and intact kidneys function. This review article of pediatric urodynamic study provides a classified diagnostic approach to bladder dysfunctions in children

Efficacy of Low-Level Laser, Hard Occlusal Appliance and Conventional Pharmacotherapy in the Management of Myofascial Pain Dysfunction Syndrome; A Preliminary Study

Introduction:Myofascial pain dysfunction syndrome (MPDS) is a common temporomandibular joint disorder. Due to its multifactorial etiology, treatment usually involves more than one modality to obtain complementary results. The purpose of this study was to compare the combined effect of low level laser, hard occlusal appliance and conventional pharmacotherapy versus pharmacotherapy only in the management of patients with MPDS.Methods: In this randomized clinical trial, 15 MPDS patients were diagnosed and randomly assigned to 3 groups (n=5). Subjects in Group 1 were treated with pharmacotherapy (PT), Group 2 received active laser (940 nm Gallium Arsenide) every other day for a total of 10 sessions, plus pharmacotherapy (PTL) and Group 3 were given hard occlusal splint 12 h/day for 4 weeks plus pharmacotherapy (PTO). The intensity of pain was measured using visual analog scale (VAS) prior to treatment, 2 and 4 weeks after treatment onset and 2 weeks later. Maximum painless mouth opening and pain intensity at muscle palpation was also recorded. Comparisons were made between groups in 4 treatment sessions via repeated measure analysis of variance (ANOVA) (P < 0.05).Results: Pain relief, in subjective VAS was observed in both laser and appliance groups in the third and fourth examination sessions, though occlusal appliance significantly showed to provide the best results between the three groups (p<0.05). No statistically significant reduction in pain was noted using pharmacotherapy only. Maximum painless mouth opening and muscle tenderness was not significantly different among the three groups (p>0.05).Conclusion: Both Laser and occlusal appliance combined with pharmacotherapy proved to be effective for pain reduction. The 3 groups however failed to result in significant improvement in maximum mouth opening or tenderness of the muscles of mastication

Clinical correlation between hypercalciuria and nocturnal enuresis

Hypercalciuria may present with dysuria, urinary incontinence and nocturnal enuresis (NE). To determine the frequency of hypercalciuria in NE patients and normally continent children, we studied 122 consecutive pre- school children with NE referred to our nephrology clinic during two years, from September 2007 to August 2009. We measured the 24- hour urinary calcium. Furthermore, we compared the response to nasal desmopressin in hypercalciuric and normocalciuric patients. Hypercalciuria was found in 26 (21.3 %) of the NE patients as compared with five (4.5%) of 110 continent children [(P 0.05). The response to desmopressin above 90% occurred within one month of therapy without a significant change in the levels of hypercalciuria. We conclude that these results suggest that hypercalciuria has a significant association with NE and does not interfere with the desmopressin therapy

Quantification of proteinuria with urinary protein to osmolality ratios in children with and without renal insufficiency.

Background: Spot urine is recommended as an accurate method to determine proteinuria in children and adults. However, urinary excretion of creatinine may vary in newborns and spot urine may be influenced by the hydration-dehydration condition of patients. The study was done to assess the validity of the urine protein to osmolality ratio versus the urine protein to creatinine ratio in health and disease conditions. Methods: We studied the correlation of the urine protein-osmolality ratio (Uprot/Uosm) and the urine protein to creatinine ratio (Up/Ucr ) and compared results with the 24-hour urinary protein excretion. Three groups were compared: children with normal renal function and without proteinuria (group 1, n=53), children with normal renal function and with proteinuria (group 2, n=52) and patients with renal insufficiency (group 3, n=45). Early morning urine samples and 24-hour urine specimens were collected for protein, creatinine, and osmolality. Results: The optimal cutoff value of the Uprot/Uosm ratio was determined to be 0.33 mg/L/mosm/kgH2O for abnormal proteinuria and 1.75 mg/L/mosm/kgH2O for nephrotic range proteinuria. In comparing ROC curves, we found no differences between the Uprot/Uosm and Up/Ucr ratios in detecting abnormal proteinuria or nephrotic syndrome in children with normal or decreased renal function (P>0.05). Conclusion: Both the Uprot/Uosm and Up/Ucr ratios from random urine specimens are good predictors of 24-hour urinary total protein excretion in children with and without renal insufficiency

Post-Pulmonary Embolism Impairment Six Months after Acute Pulmonary Embolism: A Prospective Registry

BACKGROUND Little evidence is available on post-pulmonary embolism impairment (PPEI), a recently defined complication of pulmonary embolism (PE) encompassing dysfunctional clinical and imaging parameters. In the present study, we sought to evaluate its frequency with a focus on the main components. METHODS In this prospective registry, we included patients with a confirmed diagnosis of acute PE and focused on those with initial right ventricular (RV) dysfunction. Their baseline, pre-discharge, and 6 month follow-up clinical and imaging characteristics were recorded. The main study outcomes were incomplete RV functional recovery, exercise capacity limitations (based on the 6 minute walk test), and their combination, which defines PPEI, within six months of acute PE. RESULTS Of 170 consecutive patients with a confirmed diagnosis of acute PE, 123 accepted to participate in the follow-up study, of whom 87 had initial RV dysfunction. The 6 month rates of incomplete RV functional recovery, signs of an intermediate-to-high echocardiographic probability of PH, and exercise limitations were observed in 58.6, 32.1, and 45.9%, respectively. A total of 22 (25.2%; 95% CI 15.5-34.4%) patients had PPEI. The RV/LV ratio and the fractional area change on discharge after acute PE were more often impaired among patients with incomplete RV recovery, exercise limitations, and a high probability of PH at 6 months. In contrast, an initial impaired RV diastolic function indices appeared to characterize patients with a limited exercise capacity at 6 months. DISCUSSION PPEI affects one fourth of patients surviving acute PE with half of them presenting with RV dysfunction or exercise limitations

Trial design: The effect of high-dose rosuvastatin on echocardiographic parameters in patients with intermediate- and high-risk pulmonary embolism – A randomized placebo-controlled trial

Background: It has been shown recently that a considerable burden of pulmonary embolism (PE) roots from an inflammatory response. The activated inflammatory cascade will be responsible for the final fibrotic response of pulmonary vascular bed, creating further mechanical obstruction which results in subsequent right ventricular (RV) dysfunction, influencing functional capacity and future prognosis. Although anticoagulants represent the cornerstone treatment of PE, the drug class has a minimal effect on the mentioned pathology. Study Design: The present study is a single-center randomized, double-blind, parallel group controlled trial with placebo which will evaluate the effect of high-intensity statin – rosuvastatin 20 mg daily on patients with intermediate-to-high-risk PE. Study population will be selected from patients for whom statin is not otherwise indicated. Primary end point of the present trial will be echocardiographic measures of RV function. We believe that the mentioned indexes represent an accurate surrogate for the functional capacity and prognosis. Our secondary end point will be the composites of PE recurrence and exertional capacity measured by 6-minute walk test. Conclusions: The result of the present trial might influence the complimentary treatment of acute PE

Supplemental Material - Post-Pulmonary Embolism Impairment Six Months After Acute Pulmonary Embolism: A Prospective Registry

Supplemental Material for Post-Pulmonary Embolism Impairment Six Months After Acute Pulmonary Embolism: A Prospective Registry by Azin Alizadehasl, Melody Farrashi, Mona Naghsbandi, Nakisa Khansari, Jamal Moosavi, Omid Shafe, Bahram Mohebbi, Hooman Bakhshandeh, Hamid Reza Pouraliakbar, Kiara Rezaei-Kalantari, Batoul Naghavi, Hamed Talakoob, Maryam Mohseni Salehi, Raheleh Kaviani, Ahmad Amin, Stefano Barco, and Parham Sadeghipour in Vascular and Endovascular Surgery</p