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ABSTRACT Background: Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. Objective: This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. Materials and Methods: Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. Results: At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. Discussion: Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. Conclusion: Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.
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ABSTRACT Introduction: Voiding diary (VD) is an important tool in the evaluation of children with voiding symptoms. Voiding frequency, maximal voided volume (MVV), average voided volume (AVV) and nocturnal volume (NV) can be extracted and are valuable in diagnosing and monitoring these disorders. Recently, ICCS has reduced the period of data recording on VD from 3 to 2 days. We hypothesized that one day voiding diary would be enough for guiding treatment. Materials and Methods: Children with overactive bladder (OAB) and primary monosymptomatic enuresis (PMNE) were oriented to fulfill a 3-day VD. Data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD), and all 3 days (3dVD) and compared according to the MVV, AVV, frequency, NV and expected bladder capacity (EBC). The Friedman, Student's t test and the Fisher's exact was used. ANOVA was used for multiple comparisons. We also used Pearson correlation test. Results: Ninety-eight children were included, 59 had PMNE and 30 OAB. Frequency, AVV and VN were similar regardless how many days the voiding episodes were recorded. Only MVV was higher by a mean of only 32 mL on 3dVD compared to 1dVD. A 1dVD has a sensitivity of 93,9% and a positive likelihood ratio of 2.2. As for the correlation of MVV and EBC it was observed that in 83% of children, MVV was lower than EBC. MVV corresponds to 67% and 69% of EBC in children with PMNE and OAB, respectively. Conclusion: We believe that 1dVD is sufficient to assess these children. It has a high sensitivity and good correlation to 3dVD in evaluating these children. Bladder capacity in this population, evaluated by maximum voided volume, was close to 68% of that obtained by the EBC.
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ABSTRACT Introduction: Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children. Materials and Methods: Five Pediatric Urologists joined a group of experts and reviewed all important issues on "Spina Bifida, Neurogenic Bladder in Children" and elaborated a draft of the document. All the members of the group focused on the same system of classification of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document. Results and Discussion: The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the first days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to first-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.
Subject(s)
Humans , Child , Urinary Bladder, Neurogenic/therapy , Spinal Dysraphism , Meningomyelocele/complications , Meningomyelocele/therapy , Intermittent Urethral Catheterization , UrodynamicsABSTRACT
ABSTRACT Introduction: Nocturnal enuresis is a highly incident chronic disorder that generates countless problems to the child and their parents. Bed-wetting has significant negative impacts on self-esteem and the performance of children. The aim of the current study is to assess the quality of life of enuretic children, as well as its association to sex and age. Patients and Methods: Thirty-nine enuretic children (23 boys) and 49 healthy children (27 boys) without any history of previous treatment for enuresis or voiding dysfunction were included. Age ranged between 6 and 11 years old. The "AUQEI" questionnaire was applied in a private environment to all children by the same researcher (psychologist) to evaluate quality of life. Results: Enuretic children displayed loss in quality of life when compared to non-enuretic (35.9% of enuretic x 16.3% of non-enuretic, p=0.035). They were mostly affected in their daily activities (p=0.02). No significant differences were found in the association of sex and gender with quality of life. These results suggest that, children with nocturnal enuresis have 2.87 times more chances of having loss in quality of life compared to non-enuretic. Conclusions: Enuresis has a great impact in quality of life of children. This impact is not related to the age or sex of the child.
Subject(s)
Humans , Male , Child , Urinary Incontinence , Diurnal Enuresis , Nocturnal Enuresis , Quality of Life , Chronic Disease , Surveys and QuestionnairesABSTRACT
ABSTRACT Purpose: Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT. Material and Methods: We interviewed 372 parents of children who had completed TT up to 48 months before the interview. The questionnaires were applied at school exits when parents went to pick their children up and at public parks. Questions included demographics, aspects related to TT, dysfunction voiding symptom score and evaluation of constipation. Results: The interviews were performed at a mean of 15.3±10.4 (0 to 47) months after the end of TT. Girls accounted for 53% of the sample. The mean age at finishing TT was 31.6±9.3 months and similar in both genders (p=0.77). TT occurred before school entry in 45.7% of the children and medical advice for TT was sought only by 4.8% of the parents. No association was observed of age at completing TT and presence of lower urinary tract symptoms (LUTS) (p=0.57) and/or constipation (p=0.98). In the univariate analysis, prematurity (OR=2.7 [95% CI 2.3-3.1], p <0.0001) and mothers who work outside their household (OR=1.8 [95% CI 1.4-2.3], p <0.0001) were associated to delayed TT. Conclusion: Children completed TT at a mean of 2 years and 7 months of age. The age of completing TT was not related to LUTS and/or constipation. Premature children and those whose mothers work outside the home finish TT later.
Subject(s)
Humans , Male , Female , Child , Toilet Training , Lower Urinary Tract Symptoms , Surveys and Questionnaires , ConstipationABSTRACT
ABSTRACT Introduction Vesicoureteral Reflux (VUR) is characterized by a retrograde flow of urine from the bladder into the ureters and kidneys. It is one of the most common urinary tract anomalies and the major cause of urinary tract infection (UTI) in the first years of life. If not properly diagnosed and treated can lead to recurrent UTI, renal scar and, in severe cases, to end stage renal disease. Despite recent advances in scientific and technological knowledge, evaluation and treatment of VUR is still controversial and there is still considerable heterogeneity in evaluation methods and therapeutic approaches. The aim of the present consensus is to give a practical orientation on how to evaluate and treat VUR. Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Vesicoureteral Reflux evaluation and treatment and elaborated a draft of the document. On November 2017 the panel met to review, discuss and write a consensus document. Results and Discussion Vesicoureteral Reflux is a common and challenging problem in children. Children presenting with Vesicoureteral Reflux require careful evaluation and treatment to avoid future urinary tract infections and kidney scars. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
Subject(s)
Humans , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapy , Vesico-Ureteral Reflux/diagnosis , Vesico-Ureteral Reflux/therapy , Brazil , Ultrasonography , ConsensusABSTRACT
ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
Subject(s)
Humans , Child , Practice Guidelines as Topic/standards , Consensus , Enuresis/diagnosis , Enuresis/therapy , Behavior Therapy/methods , Algorithms , Cholinergic Antagonists/therapeutic use , Deamino Arginine Vasopressin/therapeutic use , Enuresis/classification , Antidiuretic Agents/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic useABSTRACT
Los Trastornos del Espectro Autista (TEA) agrupan diversos cuadros clínicos que se caracterizan por presentar alteraciones del desarrollo con deficiencias en las áreas de comunicación, conducta e interacción social. Su prevalencia ha presentado un importante aumento desde 4 a 5 por 10.000 hasta 10 por 10.000 niños. Las manifestaciones clínicas son características según cada etapa evolutiva y, tanto la adaptabilidad al medio, como el pronóstico final van a depender del desarrollo intelectual alcanzado y de la rehabilitación psicosocial temprana. El pronóstico de vida es igual al de la población general y los autistas adultos presentan generalmente cuadros de agitación psicomotora y de adaptación, tanto depresivos como ansiosos. El origen de las TEA es neurobiológico, se remonta a etapas tempranas del desarrollo fetal o infantil y está relacionado con factores genéticos complejos. El abordaje psicofarmacológico es inespecífico y va dirigido a corregir las alteraciones conductuales que priman en cada caso.
Autism Spectrum Disorders (ASD) are severe developmental diseases marked by significant impairment in social, behavioral, and communicative functioning. Their prevalence has increased from earlier estimates of 4 to 5 per 10.000 to about 10 per 10.000. Symptoms are age specific. Intellectual development and early psychosocial rehabilitation are the most important prognostic factors. Life expectancy is similar to that of the general population. In adult life, comorbidity with anxiety disorders or depression and aggression toward self and others may appear. The assumption is that ASDs are of neurobiological origin beginning before birth or in very early child development and involve complex genetic factors. The psychopharmacotherapy of autistic disorders involves treating behavioral symptoms.
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Humans , Male , Female , Child , Adult , Autistic Disorder/diagnosis , Autistic Disorder/drug therapy , Neurobiology , Prognosis , PsychopharmacologyABSTRACT
Com o intuito de determinar a dinâmica de transmissäo da malária no povoado Charambirá(Chocó), Colombia, foi estudada a estrutura etária do mosquito Anopheles neivai (reconhecido vetor da Costa Pacífica) com base em seu estado gonadotrófico . As coletas foram realizadas intradomiciliarmente no crepúsculo vespertino com isca humana e auxílio de tubos de sucçäo manual. Os mosquitos coletados foram mantidos em caixas cilíndricas de papeläo, contendo papel umidecido e alimento. Dos 200 mosquitos dissecados entre setembro e outubro de 1986,68 (34%) apresentaram vestígios de menos de três oviposturas (oviposiçöes) e os demais (66%) apresentavam, pelo menos, três oviposturas. A diferença entre o primeiro grupo considerado como mosquitos "näo infectantes" e o segundo como os "potencialmente infectantes" foi muito significativa (X**2=10,68;P = 0,001). Dos A.neivai estudados, 15% apresentavam vestígios correspondentes a 100 oviposturas, mostrando uma acentuada longevidade e múltiplos repastos sangüíneos. Os resultados obtidos sugeriram a existência de alto risco de contrair malária em Charambirá durante o crepúsculo vespertino
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Animals , Humans , Malaria/transmission , Anopheles/anatomy & histology , Gonads/anatomy & histology , Oviposition , Risk , Colombia , Longevity , Anopheles/physiologyABSTRACT
En Charambirá, localidad del município de Istmina (Chocó) en la costa Pacífica de Colombia, donde existe un problema de malaria endêmica, se estudió la fluctuación de la población larval y las características de los criaderos de Anopheles (Kerteszia) neivai, especie considerada como posible vectora de malaria en esa región del país. La vegetación circundante fué dividida en tres estratos de acuerdo al grado de cobertura foliar. Se demarcaron cuadrantes de 100 m2 en cada estrato para el muestreo de plantas epíftas de la família Bromeliaceae, en las cuales se acumula agua que sirve como criadero para esta especie de anofelino. Se tomaron datos de temperatura, pH y volumen del agua contenida en cada bromelia. El mayor número de larvas se detectó en el estrato 1 (manglar) a una altitud inferior a 4 m, pero no se encontró evidencia significativa de estratificación vertical de la apoblación larval de A. neivai hasta los 8 m. Se evidenció una correlación lineal positiva entre el número de larvas y el volumen de agua contenida en cada bromelia; por otra parte se observó también una correlación directa entre la precipitación mensual acumulada y la fluctuación poblacional de esta especie. Los índices larvales mas altos se observaron entre los meses de marzo a abril y de julio a agosto. La mortalidad larval fué alta en el primer estadio (43,5
Subject(s)
Animals , Disease Vectors , Larva , Anopheles/growth & development , Colombia , Insect Vectors , Malaria/epidemiologyABSTRACT
En la localidad de Charambirá, situada en el município de Istmina (Chocó) en la costa Pacífica de Colombia, se presenta un problema de malaria endêmica asociada con grandes poblaciones de mosquitos Anopheles del subgénero Kerteszia (A. neivai). Estos se crían en las colecciones de agua formadas por plantas epífitas de la família Bromeliaceae, que son muy abundantes en los árboles de mangle. En esa localidad se estudiaron: fluctuación poblacional y algunos aspectos ecológicos y etológicos de los adultos de esa especie de mosquito, con el objetivo de determinar su papel en la tranmisiòn de malaria. Todos los mosquitos fueron colectados por cebos humanos. Los picos máximo de actividad ocurrieron en las horas crepusculares de la mañana y de la tarde (5:30 a 6:30 y 18:00 a 19:00 horas). En el período nocturno la actividad intradomiciliar fué baja y no hubo ninguna durante el día. El estado gonadotrófico de las hembras colectadas durante nos picos de actividad, mostró la existencia de dos poblaciones de mosquitos: una, en su mayoría individuos jóvenes que buscam su alimento en las horas de la tarde y la otra compuesta por individuos mas longevos, que buscam su alimento en la mañana. El estudio de la variación estacional mostró que las poblaciones son bajas en los meses de poca precipitación, pero a medida que aumenta el índice pluviométrico, aumenta el número de mosquitos. Se discute la relación que existe entre la presencia de los mosquitos y la prevalencia de malaria humana; se sugiere que A. neivai puede ser el responsable de la transmisión de malaria en la zona estudiada.
Subject(s)
Animals , Disease Vectors , Malaria/transmission , Anopheles , Colombia , Insect Vectors , Malaria/epidemiologyABSTRACT
El estudio del comportamiento de picadura de mosquitos capturados picando humanos en un área despejada del poblado de Charambirá, Chocó, en la costa Pacífica de Colombia, indicó que cambios en la intensidad de la luz, influenciaban el início y el fin de la actividad de vuelo de Anopheles (Kertszia) neivai, especie con marcados hábitos crepusculares. Esta especie está considerada como vectora de esa enfermedad, malaria, en la costa pacífica colombiana.
Subject(s)
Animals , Disease Vectors , Insect Bites and Stings , Anopheles , Photic Stimulation , Colombia , Insect Vectors , Malaria/epidemiologyABSTRACT
Entre los anos 1984 y 1985 se colectaron larvas y mosquitos de Anopheles (Kerteszia) en diferentes localidades de la costa del pacifico colombiano: El Trueno, Concherito y Santa Cruz, en el Rio Naya; Juanchaco y Ladrilleros, en el departamento del Valle del Cauca; y Charambira, en el Departamento del Choco. Los muestreos iniciales parecian indicar el hallazgo de dos especies: A.neivai y A.homunculus. Debido a ciertas dudas que se originaron en algunas diferencias morfologicas en los especimenes estudiados, se realizaron observaciones mas detalladas, y se llego a la conclusion de la presencia de una sola especie, A. neivai, con variaciones fenotipicas, que plantean algunos problemas de tipo taxonomico y posiblemente epidemiologico