ABSTRACT
Introduction: The incidence of antenatally detected genitourinary abnormalities is on the rise. Although this has led to earlierinterventions and better prognosis, there is a lack of standardization and uniformity in the diagnosis of urinary tract dilatation (UTD)which has resulted in more confusion than before regarding the management. Entities such as “prominent pelvis,” “pelviectasis,”and “hydronephrosis” have been used without any objective criteria which lead to unnecessary and extensive postnatal evaluation.Aim: This study aims to study the imaging features of those infants with antenatally diagnosed fetal urinary tract dilation andto standardize the protocol for postnatal follow-up and management.Materials and Methods: A prospective study of 72 mothers who were antenatally diagnosed with fetal UTD were enrolledfor the study and postnatal follow-up done by imaging with ultrasound, voiding cystourethrogram, and intravenous urogram.Results: Among the 72 enrolled cases of 24 were categorized under UTD A1, nine children were managed conservativelywith regular follow-up. Those categorized under UTD P1, six cases had normal postnatal scans at the 1st week of life and at1 month, of which three cases had transient hydronephrosis and two had partial pelviureteric junction obstruction (PUJO). Of14 children with intermediate-risk dilation UTD P2, 11 children had complete PUJO, two had partial PUJO, and one had bilateralvesicoureteric reflux (VUR), of which patients with complete PUJO required pyeloplasty and the rest needed only observation.Among the 20 neonates with UTD P3 high-risk dilatation, 10 cases of posterior urethral valve, six cases of complete PUJO, onecase of obstructive megaureter, one case of VUR, one case of bilateral ureterocele, and one case of non-neurogenic bladder,all of which required surgical intervention except in case of VUR.
ABSTRACT
Se compara el impacto de tres estrategias distintas de medidas no farmacológicas (MNF) en tres colegios de la Región Metropolitana en Chile para controlar el brote de influenza AH1N1: colegio A) con suspensión de clases,colegio B) con suspensión selectiva y colegio C) sin suspensión de clases y sin administración de antivirales. Utilizando cuestionarios e información de los colegios, los datos recolectados indican que la tasa de incidenciaacumulada fue 40,3 por ciento (colegio A), 39,6 por ciento (colegio B) y 42,5 por ciento (colegio C). Al restringir la comparación a los dosúltimos colegios, es decir, aquellos en los que la suspensión de clases fue selectiva o bien no hubo suspensión, larazón de tasas (ajustada) del colegio C vs. B fue 1,09 (p = 0,473). A pesar de no alcanzar significancia estadística,este resultado apoya la hipótesis de que la suspensión selectiva de clases tuvo un impacto en reducir la magnituddel brote infeccioso. Los beneficios de una suspensión selectiva de clases (menor tasa de incidencia acumulada ydensidad de incidencia) tienen asociada, sin embargo, una limitación debido a una mayor inasistencia a clases.
The impact of three different strategies of nonpharmacologic measures (MNF) at three schools in the Metropolitan Region in Chile to control outbreaks of influenza AH1N are compared: school A) suspension of classes, school B) selective suspension, C) no suspension of classes and without administration of antiviral drugs. Data collected through questionnaires and information from schools, indicate that the incidence rate was 40.3 percent (school A), 39.6 percent (school B) and 42.5 percent (school C). Restricting the comparison to the last two schools, ie those in which the suspension of classes was selective or no suspension, the rate ratio (adjusted) of C school vs B was 1.09 (p = 0.473). Although not statistically significant, this result supports the hypothesis that the selective suspension of classes had an impact in reducing the magnitude of the outbreak. The benefits of selectively discontinuing classes (lower cumulative incidence and incidence density) are counterbalanced, however, by the limitation of higher non-attendance to school.