RESUMEN
The presence of renal scarring has been documented in 5% to 15% of febrile urinary tract infections. The main aim of this study was to compare the value of renal ultrasonography and cortical scintigraphy with technetium-99m dimercaptosuccinic acid [DMSA] in detecting renal cortical defects in acute pyelonephritis. Between June 2003 and February 2012 a prospective cohort study of patients aged 1 month to 14 years of age was conducted. Pediatric patients with documented urinary tract infections were evaluated with renal ultrasonography, voiding cystoureterography [VCUG] and DMSA scintigraphy. Statistical test was two-tailed and was considered significant when P< 0.05. The results of DMSA scans showed 70.2% of cases as being abnormal. Renal ultrasonographies were reported to be normal in 72.45 and showed mild hydronephrosis in 37.7% of cases, moderate to severe hydronephrosis in 40.62%, stone formation in 13.66% and scar formation or decreased cortical thickness in 8.2%. There was a significant difference in ultrasonography reports between patients with normal and abnormal DMSA scans [P< 0.012] but there was no significant difference in detection of scar formation between DMSA scan results and those of ultrasonography in our patients. Among patients with severe abnormalities on DMSA scintigraphy the percent of cases with vesicoureteral reflux was significantly higher than those with normal scans or mild to moderate changes on DMSA scintigraphy. [46.3% vs 26.9%]. We concluded that ultrasonography is a sensitive method for detection of renal cortical defects and ultrasonography can also predict the presence of vesicoureteral reflux in pyelonephritic patients
RESUMEN
Acute Renal Injury [AKI] is a frequent clinical condition in the Neonatal Intensive Care Units [NICUs]. Most AKI causes are preventable; performing rapid preventive, diagnostic, and therapeutic measures could prevent the potential complications. The present study was conducted to define the risk factors and mortality rates of neonates with and without AKI admitted in the NICU of a tertiary care hospital. Demographic and biochemical data of NICU of Mahdieh Hospital were collected and analyzed. More than twofold increase in normal serum creatinine level or >0.8 mg/dl [for infants > 4 days age] was defined as AKI. All newborns were divided into two groups: with and without AKI. Risk factors and mortality rates were compared in the 2 groups. The mortality rate of newborns with AKI was 4.5%. The other risk factors for mortality in neonates with AKI were as follows: Hyaline Membrane Disease [HMD] [P <0.03], using mechanical ventilation [P <0.041], using surfactant [P <0.04], first minute Apgar score <5, PC02 >60 mmHg [P <0.035], birth weight < 2500 g [P <0.003] and serum creatinine [SCr] level >1 mg/dl [P <0.003]. ROC Curve revealed that low birth weight was the most significant risk factor for mortality of neonates with AKI admitted in the NICU. Mortality related to AKI was associated with HMD, using mechanical ventilation, the need to surfactant use, low Apgar score, high blood PC02, high serum creatinine level, and low birth weight
RESUMEN
This study was conducted to evaluate whether forced expiratory volume in 1 second FEV[1] for the diagnosis of bronchial reactivity by means of the free-running exercise test and bronchodilator inhalation, could be appropriately replaced by simple measurements of peak expiratory flow rate [PEFR] in children. We studied 108 referred symptomatic children [due to chronic cough or wheezing] suspected to have asthma aged 5-14y. Forced breathing spirometry and the [Mini-Wright peak flow meter] tests were recorded before and fifteen minutes after the challenge with free- running exercise or bronchodilator [Salbutamol] inhalation, regarding the baseline FEV[1] value [FEV[1]> 80% considered as normal]. There was a high correlation between PEFR and FEV[1] [in absolute value and percent predicted] measured before and after bronchodilator inhalation test [r = 0.48, P = 0.05] in comparison to the values referred to free- running exercise test [r = 0.26, P = 0.01]. [forced breathing spirometry] and [Mini-Wright peak flow] cannot be used interchangeably for diagnosing asthma, and PEFR measurement should remain a procedure for monitoring and following up the patients