ABSTRACT
Objective: To determine the applicability of urinary caspase 3 enzyme and TNF-alpha as biomarkers in children with ureteropelvic junction obstruction [UPJO]
Methods: In this study, 31 unilateral UPJO patients and 33 age- and sex-matched healthy childrens were enrolled. The patients with UPJO consisted of 11 female and 20 male children between the ages of 2 to 62 months old. All participants were evaluated regarding anterior-posterior[AP] diameter and cortical thickness of affected kidney by ultrasonography. Technetium DTPA renal scan and voiding cystourethrogram[to assess vesicoureteral reflux] were performed, pre-operatively. Also, urinary levels of TNF-alpha and caspase 3 enzyme were checked. Follow-ups included measurement of aforementioned indices in patients: AP diameter and cortical thickness of the affected kidney, as well as TNF-alpha and caspase 3 levels in urine, three and six months after pyeloplasty
Results: The results showed highly significant decrease in urinary TNF-alpha and caspase 3 enzyme [P values < 0.01], approaching the level measured in children without UPJO after six months. Significant decrease in AP diameter and increase in cortical thickness were also noticed [P values < 0.01]
Conclusion: The results of this study strongly support that TNF-alpha and caspase 3 levels in urine can be used for improvement monitoring in follow-up of UPJO patients after pyeloplasty and can also be potentially used as determining indices for surgical plan but more studies, especially in patients who are not surgical candidates are needed to confirm our observaitons
ABSTRACT
Background and Objective: Management of post operative pain in children undergoing hypospadiasis repair, accounts for optimized surgery outcomes and improved patients' satisfaction. Thus, various studies have widely investigated the best approaches for the pain management. In this study our aim was to determine the effect of dexamethasone in combination with penile nerve block on the postoperative pain and complications in the children undergoing hypospadias surgery
Methods: In this randomized double-blind placebo controlled trial, after obtaining informed consent from parents or legal guardians, 42 children undergoing surgical treatment of hypospadias were randomized in two groups to receive either IV dexamethasone 0.5 mg/kg [n=23] or placebo [normal saline] [n=19] during the operation. Penile block was performed in both groups using Bupivacaine 0.5% [1mg/kg] at the end of the procedure. By the end of the operation, FLACC [Face, Leg, Activity, Cry, Consolability] pain score was assessed as the primary outcome of the study. Secondary outcomes includes timing and episodes of rescue medication consumption, post operative nausea /vomiting and bleeding. All the outcomes were assessed in the recovery room and after 2, 6, 12, and 24 hours
Results: The median of FLACC pain scores at the recovery room and 2, 6, 12, and 24 hours post operation was 2, 1, 1, 1, and 2 for the dexamethasone group and 8, 8, 7, 7, and 8 for the placebo group respectively. This were significantly different [P<0.000]. The median time of first rescue medication consumption was 8 hours post operation for the dexamethasone group and three hours for the placebo group which was significantly different [z= 4.57, p<0.000]. The maximum episode of post operative rescue medication consumption in dexamethasone group was 4 episodes in only one patient and the minimum was one episode in 11 patients. In comparison numbers in placebo group were five episodes in seven patients and three episodes in four patients. The result indicated that there was statistically significant difference between two groups in terms of episodes of rescue medication consumption [Chi2= 31.4, p<0.000]
Conclusion: Single dose of intravenous dexamethasone [0.5 mg/kg] in combination with penile block decreased the post operative pain measures, and total post operative analgesic requirement. It also increased the onset of the first analgesic requirement compared to penile block alone