Comparison of Recurrent Urinary Tract Infection in Children with Different Grades of Vesicoureteral Reflux

Background and Objective: Urinary reflux is the most common urological abnormality in children. About half of the children with urinary infection have urinary reflux at the same time. Considering the importance of urinary reflux in children and contradictory results reported regarding the relationship between different grades of vesicoureteral reflux and recurrent urinary tract infection, this study was conducted with the aim of comparing recurrent urinary tract infection in children with different grades of vesicoureteral reflux. Methods: This cross-sectional study was conducted on 150 children with pyelonephritis and vesicoureteral reflux who refered to Amirkola Children's Hospital in 2011-2019. Reflux grades were determined by voiding cystourethrogram (VCUG) or direct radionuclide cystography (DRNC). Children were followed up for 2 years and in case of clinical symptoms with positive urine culture, they were considered as recurrent urinary tract infection. Findings: Of the 150 children studied, 126 (84%) were girls and 24 (16%) were boys with a mean age of 27.17±11.53 months. 95 people (63.3%) had once, 37 people (24.7%) twice, 8 people (5.3%) three times, and 10 people (6.7%) four times experience of recurrent urinary tract infection. The odds ratio of recurrent urinary tract infection was more than two times higher in children with grade 3 and 4 reflux involvement than in children with grade 1 and 2 reflux (OR=3.20, 95% CI=1.05-9.75, p=0.041). However, there was no significant difference in recurrent urinary tract infection in children based on age at diagnosis, gender, and whether the reflux was unilateral or bilateral. Conclusion: The results of the study showed that children with moderate and severe involvement of vesicoureteral reflux experience higher recurrent urinary tract infection compared to mild involvement

Comparision of Aqueous and Hydroalcoholic Extracts of Foeniculum Vulgare and Carum Copticum with Gentamicin on Escherichia Coli Strains: in Vitro Study

BACKGROUND AND OBJECTIVE: Due to bacterial resistance to antibiotics, new antibacterial agents is essential. In Persian medicine Fennel (Fuenoculum vulgare Mill.) and Ajwain (Carum copticum (L.) Benth. & Hook.f.) are recommended for the treatment of some infections. In this research, bacteriostatic and bactericidal effects of aqueous and hydroalcoholic extracts of fennel and Ajwain on E. coli were investigated. METHODS: In an in-vitro study 30 clinical isolates of urine culture of children with urinary tract infection from Amirkola Pediatric Hospital in Babol and a standard sample were used. Antibacterial effects of 4 grouos including aqueous and hydroalcoholic extracts of fennel and Ajwain by measuring the diameter of the inhibition zone using disc diffusion (concentrations 16, 32, 64, 128, 256 and 512 mg/disc) and determination of Minimum Inhibitory Concentrations (MIC) and Minimum Bactericidal Concentration (MBC) with Microdilution method was compared with Gentamicin (30mg/disc) as a positive control FINDINGS: There was no significant difference in inhibition zone with Gentamicin at concentrations of 64, 128, 256, and 512 mg/disc in standard and clinical samples. At concentrations of 16 and 32, Gentamicin was significantly better. The extract of 512 mg/disc (12.93±2.66) of hydroalcoholic extract of Carum copticum was significantly better than 256 mg/disc (9.53±1) (p=0.002). The MIC and MBC for standard samples were 4 and 8, respectively, and for clinical samples 3.83±2.36 and 5.8 mg / ml, respectively. Other extracts were not able to inhibit the growth of Escherichia coli. CONCLUSION: The results showed that the Hydroalcoholic extract of Carum copticum has bacteriostatic and bactericidal effects on standard and clinical isolates of Escherichia coli

A Rare Case of Intussusception in A COVID-19 Positive Patient with Nephrotic Syndrome

Background and Objective: Intussusception is one of the most common causes of intestinal obstruction in children 5 months to 3 years, which is the most common cause of acute abdominal pain and its prevalence increases as a result of viral infection. In this report, were present a case of intussusception in a 17-years-old boy following COVID-19. Case Report: A 17-year-old adolescent boy with a known case of steroid-dependent nephrotic syndrome from the age of two has been referred to the emergency department with severe abdominal pain and vomiting. On ultrasound, renal mass and free fluids were shown. Ileocecal intussusception was observed and was repaired without any complications. Conclusion: Based on the results of this study, intussusception should be considered in every patient with nephrotic syndrome with COVID-19 infection

Spontaneous Vesicoureteral Reflux Resolution among Infants Aged Less Than One Year

BACKGROUND AND OBJECTIVE: Vesicoureteral reflux (VUR) followed by urinary tract infection (UTI) is a major contributing factor to kidney failure, especially during early childhood. This study aimed to evaluate the possibility of spontaneous high-grade VUR resolution in infants aged less than one year. METHODS: This cross-sectional study was conducted at Amirkola Children’s Hospital of Babol, Iran on all the infants aged less than one year with high-grade VUR (III-V). Infants were followed-up in terms of at least one kidney per age, reflux grade, and kidney failure for two years. Evaluation of reflux resolution was performed using voiding cystourethrography (VCUG) and radionuclide cystography (RNC) each year. In addition, presence of kidney failure was assessed via dimercaptosuccinic acid (DMSA) scan within at least 4-6 months after the last UTI diagnosis. Data analysis was performed in SPSS V.22 using Chi-square and Kaplan-Meier survival analysis, and P value of less than 0.05 was considered statistically significant. FINDINGS: In total, 97 kidneys in 49 infants were evaluated (one infant had only one kidney). Among the studied patients, 29 infants (59.2%) were female, and mean age of the study population was 5.9±3.66 months. Out of 49 infants with VUR, complete recovery was observed in 33 cases (67.3%), while partial resolution (reduced grade of reflux) was reported in 13 cases (26.5%), and lack of resolution was observed in 3 cases (6.1%). CONCLUSION: According to the results of this study, spontaneous resolution of high-grade VUR could occur in a high percentage of infants aged less than one year. Therefore, it is recommended that early surgical operation be reconsidered for this patient populatio

Comparison of Bladder Wall Thickening and Presence of Internal Echoes Within the Bladder for the Diagnosis of Cystitis in Infants

WOS: 000471326300015Background: Cystitis is very common in children and the diagnosis is usually made based on clinical findings with laboratory examinations including urinalysis and urine culture. Bladder wall thickening and presence of fine nodule shaped echoes within the bladder are the suggested sonographic findings of cystitis. Objectives: In this study we aimed to compare diagnostic value of bladder wall thickening and presence of fine nodule shaped echoes within the bladder and also perivesical fluid collection for cystitis in infants by correlating urinalysis results. Methods: Urinary tract ultrasound and urinalysis results of a total 1094 infants were retrospectively screened. Patients were classified as groups according to presence of internal echoes in bladder lumen and/or bladder wall thickening and/or perivesical fluid collection. Control group was constituted of the patients who had normal ultrasound results. Also three subgroups of group 2 (the patients with only bladder wall thkening, P2) were classified according to the size of the thickening. Comparison of pathological urinalysis rate of each group with control group was made with statistical analysis. Also subgroups of group 2 (P2) were compared with each other. Results: When compared with control group, all the groups except perivesical fluid group (P1), had statistically significantly higher pathological urinalysis rates (P < 0.05). The pathological urinalysis rates are highest in the thickened wall and echoes in the lumen and perivesical fluid group (P8) and in the thickened wall and echoes in the lumen without perivesical fluid group (P7) (60% and 54.5%, respectively). Also among subgroups of group 2, pathological urinalysis rate was highest in subgroup 3 in which the patients had most thickened bladder wall and the difference was found to be statistically significant (P < 0.005). Conclusions: We suggest that when thickened wall or echoes in the lumen or perivesical fluid collection accompany each other, pathological urinalysis rates increase. Also pathological urinalysis rates increase as the size of thickness of bladder wall increases

Comparison of Recurrent Urinary Tract Infection in Children with Different Grades of Vesicoureteral Reflux

Background and Objective: Urinary reflux is the most common urological abnormality in children. About half of the children with urinary infection have urinary reflux at the same time. Considering the importance of urinary reflux in children and contradictory results reported regarding the relationship between different grades of vesicoureteral reflux and recurrent urinary tract infection, this study was conducted with the aim of comparing recurrent urinary tract infection in children with different grades of vesicoureteral reflux. Methods: This cross-sectional study was conducted on 150 children with pyelonephritis and vesicoureteral reflux who refered to Amirkola Children's Hospital in 2011-2019. Reflux grades were determined by voiding cystourethrogram (VCUG) or direct radionuclide cystography (DRNC). Children were followed up for 2 years and in case of clinical symptoms with positive urine culture, they were considered as recurrent urinary tract infection. Findings: Of the 150 children studied, 126 (84%) were girls and 24 (16%) were boys with a mean age of 27.17±11.53 months. 95 people (63.3%) had once, 37 people (24.7%) twice, 8 people (5.3%) three times, and 10 people (6.7%) four times experience of recurrent urinary tract infection. The odds ratio of recurrent urinary tract infection was more than two times higher in children with grade 3 and 4 reflux involvement than in children with grade 1 and 2 reflux (OR=3.20, 95% CI=1.05-9.75, p=0.041). However, there was no significant difference in recurrent urinary tract infection in children based on age at diagnosis, gender, and whether the reflux was unilateral or bilateral. Conclusion: The results of the study showed that children with moderate and severe involvement of vesicoureteral reflux experience higher recurrent urinary tract infection compared to mild involvement

The Relationship between Hyponatremia and Bacterial and Non-Bacterial Meningitis and Its Complications

Background and Objective: Considering the lack of knowledge and the difference in the prevalence of hyponatremia in non-bacterial meningitis and bacterial meningitis, this study was conducted with the aim of determining the relationship between hyponatremia and bacterial and non-bacterial meningitis and its complications. Methods: This cross-sectional study was conducted on 183 children with meningitis referred to Shafizadeh Amirkola Children's Hospital in three age groups: 1 month to 2 years, 2-5 years, and 5-18 years. Based on cerebrospinal fluid analysis, cases of bacterial meningitis were considered to be WBC>100 with preference for PMN, glucose less than 40% of serum sugar and protein more than 1 g/L or positive culture or smear. Cases of non-bacterial meningitis were considered as WBC<100 with preference for lymphocyte, glucose more than 60% of serum sugar and protein less than 1 g/L or negative culture or smear. Gender of children, duration of hospitalization and occurrence of seizures in two groups of bacterial and non-bacterial meningitis with and without hyponatremia were investigated and compared. Findings: In this study, the mean age of boys (68.26±47.10) with meningitis was higher than that of girls (42.56±32.50) (p<0.001). The mean age of meningitis patients with hyponatremia (51.87±47.56) was lower than that of patients without hyponatremia (72.54±45.03) (p=0.002). The frequency of hyponatremia in children with meningitis aged less than 2 years compared to other age groups (52 patients) (p=0.002), as well as infants who had seizure (37 patients) (p=0.001) has been significantly higher. In children who had hyponatremia, the duration of hospitalization was significantly longer (108 patients) (p=0.01). Conclusion: Based on the results of the present study, it was found that younger children are at greater risk for hyponatremia, and the presence of hyponatremia at the beginning of diagnosis suggests a greater risk for seizures and increased length of hospitalization. However, the risk of hyponatremia in both types of bacterial and non-bacterial meningitis is almost the same