Risk factors for hemorrhagic cystitis in children with β-thalassemia major after allogeneic hematopoietic stem cell transplantation / 中国当代儿科杂志

OBJECTIVES@#To explore the risk factors for hemorrhagic cystitis (HC) in children with β-thalassemia major (TM) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).@*METHODS@#A retrospective analysis was conducted on clinical data of 247 children with TM who underwent allo-HSCT at Shenzhen Children's Hospital from January 2021 to November 2022. The children were divided into an HC group (91 cases) and a non-HC group (156 cases) based on whether HC occurred after operation. Multivariable logistic regression analysis was used to explore the risk factors for HC, and the receiver operating characteristic curve was used to analyze the predictive efficacy of related factors for HC.@*RESULTS@#Among the 247 TM patients who underwent allo-HSCT, the incidence of HC was 36.8% (91/247). Univariate analysis showed age, incompatible blood types between donors and recipients, occurrence of acute graft-versus-host disease (aGVHD), positive urine BK virus deoxyribonucleic acid (BKV-DNA), and ≥2 viral infections were associated with the development of HC after allo-HSCT (P<0.05). Multivariable analysis revealed that incompatible blood types between donors and recipients (OR=3.171, 95%CI: 1.538-6.539), occurrence of aGVHD (OR=2.581, 95%CI: 1.125-5.918), and positive urine BKV-DNA (OR=21.878, 95%CI: 9.633-49.687) were independent risk factors for HC in children with TM who underwent allo-HSCT. The receiver operating characteristic curve analysis showed that positive urine BKV-DNA alone or in combination with two other risk factors (occurrence of aGVHD, incompatible blood types between donors and recipients) had a certain accuracy in predicting the development of HC after allo-HSCT (area under the curve >0.8, P<0.05).@*CONCLUSIONS@#Incompatible blood types between donors and recipients, occurrence of aGVHD, and positive urine BKV-DNA are risk factors for HC after allo-HSCT in children with TM. Regular monitoring of urine BKV-DNA has a positive significance for early diagnosis and treatment of HC.

Migración de un dispositivo intrauterino a vejiga con litiasis vesical secundaria y cistitis recurrente como forma clínica de presentación. Reporte de caso / Migration of an intrauterine device to the bladder with secondary bladder lithiasis and recurrent cystitis as a clinical presentation. Case report

RESUMEN Fundamento: El dispositivo intrauterino ha sido utilizado durante muchos años como método anticonceptivo; una complicación infrecuente posterior a su inserción es la migración fuera del útero. La localización vesical y la formación de vesicolitiasis, son complicaciones asociadas a la migración. Objetivo: Presentar un caso de migración de un dispositivo intrauterino a vejiga con litiasis sobreañadida como inusual etiología de una cistitis recurrente. Presentación del caso: Caso clínico de un dispositivo intrauterino en vejiga en una paciente de 43 años, cuyo diagnóstico se realizó incidentalmente en estudio de cistitis recurrente; se diagnosticó imagenológica y endoscópicamente en consulta de Urología; se decidió tratamiento quirúrgico mediante cistolitotomía a cielo abierto y se extrajo un cálculo de 4x5 cm de diámetro. La paciente evolucionó satisfactoriamente. Conclusiones: Considérese la posibilidad de migración del dispositivo intrauterino a la vejiga con litiasis sobreañadida como causa de cistitis recurrente, en pacientes femeninas que tengan antecedente de uso de este método anticonceptivo, lo que constituye un elemento importante en el diagnóstico y tratamiento de la infección urinaria baja.

ABSTRACT Background: The intrauterine device has been used for years as a contraceptive method; a non-frequent complication after its insertion is migration out of the uterus. The bladder location and the formation of vesicolithiasis are complications associated with migration. Objective: To present a migration case from an intrauterine device to the bladder with overadded lithiasis as an unusual etiology of recurrent cystitis. Case report: Clinical case of an intrauterine device in the bladder in a 43-year-old patient, whose diagnosis was made incidentally in a recurrent cystitis study, it was diagnosed by imaging and endoscopy in the Urology consultation; surgical treatment was decided by means of open cystolithotomy and a stone 4x5 cm in diameter was extracted. The patient evolved satisfactorily. Conclusions: To consider the possibility of migration of the intrauterine device to the bladder with overadded lithiasis as a cause of recurrent cystitis in female patients who have a preceding use of this contraceptive method, thus it constitutes an important element in the diagnosis and treatment of urinary lower infection.

Migración de dispositivo intrauterino a vejiga / Intrauterine device migration to bladder

Introducción: La litiasis vesical secundaria se forma en el reservorio vesical y requiere la existencia de condiciones patológicas previas como lo son los cuerpos extraños. Objetivo: Describir dos casos clínicos de litiasis vesical secundaria a migración de un dispositivo intrauterino. Caso clínico: Se presentan dos casos de migración intravesical de dispositivo intrauterino con litiasis vesical secundaria. Se diagnosticaron años después de su inserción, ante la aparición de dolor pélvico, cistitis a repetición y hematuria. La laparoscopia no fue útil para su diagnóstico. En consulta de Urología la ultrasonografía y la radiografía de pelvis fueron herramientas diagnósticas útiles ante la sospecha inicial de esta patología. Presentaron buena evolución y regresión total de los síntomas tras cistolitotomía suprapúbica. Conclusión: Se debe pensar en la posibilidad de migración de un dispositivo intrauterino a vejiga ante la cronicidad de síntomas urinarios irritativos bajos en toda mujer que emplee este método anticonceptivo y desconozca su paradero(AU)

Introduction: Secondary bladder lithiasis is formed in the bladder reservoir and requires the existence of previous pathological conditions such as foreign bodies. Objective: To describe two clinical cases of bladder lithiasis secondary to intrauterine device migration. Clinical case report: Two cases of intravesical migration of an intrauterine device with secondary bladder stones are reported. They were diagnosed years after insertion, due to the appearance of pelvic pain, recurrent cystitis and hematuria. Laparoscopy was not helpful for its diagnosis. In Urology consultation, ultrasound and pelvic radiography were useful diagnostic tools in the event of the initial suspicion of this pathology. They showed good evolution and total regression of symptoms after suprapubic cystolithotomy. Conclusion: The possibility of an intrauterine device migration to the bladder should be considered when chronicity of irritative low urinary symptoms in every woman who uses this contraceptive method and which locations are unknown(AU)

Infecção urinária multirresistente na gravidez / Multiresistant urinary infection in pregnancy

Os micro-organismos que apresentam mecanismos de resistência aos antimicrobianos, como produção de ß-lactamase de espectro estendido (ESBL), resultam em uma maior dificuldade no tratamento e exigem a utilização de antibióticos de largo espectro com frequência crescente. Assim, este estudo busca revisar a literatura sobre as infecções causadas por micro-organismos multirresistentes na gravidez. Foi realizada uma busca de artigos no PubMed, MedLine e Lilacs usando-se unitermos, incluindo-se os estudos publicados de 2000 a 2016, de línguas portuguesa e inglesa, envolvendo apenas seres humanos. Foram selecionados 59 artigos com força de evidência A e B. Os critérios para inclusão no estudo são: estarem grávidas e terem diagnóstico de infecção do trato urinário. Serão critérios de exclusão: uso de antimicrobiano a menos de duas semanas antes da coleta da amostra e portadoras de doença imunossupressora. A verdadeira prevalência de ITU em gestantes por bactérias multirresistentes é desconhecida. As ITUs por bactérias produtoras de ESBL variam entre 1% e 40%. O tratamento mais aceito para os casos mais graves (pielonefrite ou bacteremia) é com carbapenêmicos. A nitrofurantoína e a fosfomicina têm sido utilizadas para tratar a cistite com patógenos produtores de ESBL com sucesso.(AU)

Microorganisms that have resistance mechanisms to antimicrobial agents, such as production of ß-lactamase extended spectrum (ESBL), result in greater difficulty in treatment and require the use of broad spectrum antibiotics with increasing frequency. This study aims to review the literature on infections caused by multiresistant microorganisms in pregnancy. A search for articles was conducted in PubMed, MedLine and Lilacs are using key words, including published studies from 2000 to 2016, Portuguese and English, involving only human. 59 articles were selected on strength of evidence A and B. The criteria for inclusion was pregnant and having diagnosed of urinary tract infection. The criteria for exclusion was: use of antimicrobial less than two weeks before sample collection and suffering from immunosuppressive disease. The true prevalence of UTI in pregnant women by multiresistant bacteria is unknown. UTIs for ESBL-producing bacteria, ranging from 1% to 40%. The treatment more acceptable for the most serious cases (pyelonephritis or bacteremia) is with carbapenems. Nitrofurantoin and fosfomycin has been used to treat successfully with cystitis ESBL producers pathogens.(AU)

Hemorrhagic Cystitis Following Allogeneic Hematopoietic Cell Transplantation

We conducted a retrospective study to investigate the incidence, risk factors, and clinical features of hemorrhagic cystitis (HC) following allogeneic hematopoietic cell transplantation (allo-HCT). Adult patients who developed HC after allo-HCT were identified from the HCT database of the Asan Medical Center and their medical records were reviewed. From December 1993 to August 2001, a total of 210 adult patients underwent allo-HCT. Fifty-one patients developed HC with a cumulative incidence of 25.7%. The median onset of HC was post-transplant day 24 (range, -2 to 474), and the median duration was 31 days (range, 8 to 369). Significant risk factors for HC by univariate analysis included diagnosis of chronic myelogenous leukemia (p=0.028), unrelated HCT (p=0.029), grade III-IV acute graft-versus-host disease (GVHD) (p<0.001), extensive chronic GVHD (p=0.001), and positive cytomegalovirus antigenemia between post transplant days 31 and 60 (p=0.031). Multivariate analysis showed that grade III-IV acute GVHD was the most important risk factor for the occurrence of HC after allo-HCT (odds ratio, 3.38; 95% CI, 1.36-8.39). Late-onset HC, which occurred beyond 3 weeks after allo-HCT, was more frequently associated with GVHD than earlyonset HC (p=0.007). Our data suggest that a portion of late-onset HC might be a manifestation of GVHD.

Urinary bladder involvement in patients with systemic lupus erythematosus with review of the literature

OBJECTIVES: To investigate the etiologies of urinary bladder involvement in patients with systemic lupus erythematosus (SLE), the clinicoradiologic features of gastrointestinal tract manifestations and clinical outcomes in patients with lupus cystitis accompanied by gastrointestinal manifestations. METHODS: We conducted a retrospective chart review on 413 patients with SLE. Patients were selected for review on the basis of lower urinary tract symptoms including urinary frequency, urgency and urinary incontinence. Radiologic studies were analyzed in patients with lupus cystitis. RESULTS: Ten consecutive patients, complicated with lower urinary tract symptoms, were identified. Underlying etiologies were as follows: lupus cystitis in five, neurogenic dysfunction secondary to transverse myelitis in three, cyclophosphamide-induced cystitis in one and tuberculous cystitis in one patient. All patients with lupus cystitis showed gastrointestinal manifestations, such as abdominal pain, nausea, vomiting and/or diarrhea during the periods of cystitis symptoms. In all patients with lupus cystitis, paralytic ileus was demonstrated on plain abdominal X-ray and ascites, bilateral hydroureteronephrosis and thickened bladder wall were identified on abdominal ultrasound or CT. Abdominal CT revealed bowel wall thickening in four of the five patients. The main sites of thickened bowel on abdominal CT were territory supplied by superior mesenteric artery. Two of five patients with lupus cystitis expired during the follow-up period. CONCLUSION: Diverse etiologies may cause lower urinary tract symptoms in patients with SLE. Lupus cystitis is strongly associated with gastrointestinal involvement and abdominal CT can be a useful radiologic tool to investigate the gastrointestinal tract involvement in patients with lupus cystitis.

Infeccao do trato urinario inferior-cistite e sindrome uretral / Lower urinary tract infection-cystitis and urethral syndrome

Os autores atualizam os mais recentes conceitos fisiopatologicos(biologia celular e molecular)clinicos, e laboratoriais da infeccao urinaria nao complicada do trato urinario inferior, da cistite e da sindrome uretral. Analisam os aspectos epidemiologicos e apresentam os avancos terapeuticos destas doencas. Avaliam os diferentes esquemas de tratamento destas doencas. Avaliam os diferentes esquemas de tratamento no que diz respeito a escolha dos antimicrobianos, da dose e sua duracao: dose unica, tres, sete dias e tratamento classico. Apresentam as perspectivas nesta area, especialmente o desenvolvimento de vacinas, atualmente sendo testadas.