Early diagnosis of solitary functioning kidney: comparing the prognosis of kidney agenesis and multicystic dysplastic kidney.

BACKGROUND: Individuals with congenital solitary functioning kidney (SFK) are at an increased risk of kidney damage. According to some studies, the risk is higher in unilateral kidney agenesis (UKA) than in unilateral multicystic dysplastic kidney (UMCDK). We hypothesized that with early detection of children with UKA and UMCDK, there would be no difference in the presence of hypertension, proteinuria, and reduced glomerular filtration rate (GFR) between UKA and UMCDK. METHODS: Based on a long-term follow-up protocol, we evaluated a cohort of 160 children followed from birth for SFK (84 with UKA and 76 with UMCDK) detected by prenatal or routine neonatal ultrasound screening. Hypertension, proteinuria, and reduced GFR were monitored as markers of kidney damage. We compared the characteristics and outcomes of the subgroups of children with UKA and UMCDK. RESULTS: GFR was reduced in 42 (26.2%) children, of whom 41 showed only mild reduction. Hypertension and proteinuria were found in 22 (13.8%) and 14 (8.8%) children, respectively. Combined kidney damage was present in 57 (35.6%) children. The UMCDK and UKA subgroups differed in GFR at final examination, with UMCDK patients being significantly more likely to have normal GFR compared to UKA patients (82% vs. 67%; p = 0.039). CONCLUSIONS: One third of the children showed signs of SFK damage, albeit mild. Patients with UKA had reduced GFR significantly more often than those with UMCDK, but did not differ in the rates of hyperfiltration injury or congenital anomalies of the kidneys and urinary tract (CAKUT) in SFK.

Screening for congenital defects and genetic diseases of the fetus at University Hospital in Olomouc and sending/ reporting to the National register of reproductive health in the Czech Republic.

OBJECTIVE: The aim of the study was to analyze the results of the screening for congenital defects (CD) and genetic diseases (GD) of the fetus in the Fetal Medicine Centre at the Department of Obstetrics and Gynecology, University Hospital in Olomouc. MATERIALS AND METHODS: Prospective cohort study. In the period from 1 January 2020 to 31 December 2021, a total of 14,460 health services were performed on 4,916 pregnant women. Within the screening of CD and GD of the fetus, 501 pregnant women were found to have an abnormality requiring further clinical management, 170 of them were diagnosed with a CD of the fetus and in 20 cases a GD of the fetus was diagnosed by a laboratory genetic examination. All diagnosed fetal CD and GD were sent/ reported according to the valid methodology of the National health information system (NHIS) to the National register of reproductive health (NRRH) to the CD Module. RESULTS: An increased calculated individual risk of genetic fetal disease was diagnosed in the first trimester of pregnancy in 10.7% of fetuses (319/ 2,968), and in the second trimester in 0.9% of fetuses (27/ 2,948). Nuchal translucency (NT) > 3.5 mm was diagnosed in 0.9% of fetuses by ultrasound examination in the first trimester of pregnancy (26/ 2,968). In fetal CD and GD screening, 501 pregnant women were found to have an abnormality requiring further clinical management, 72.1% of women (361/ 501) had an increased risk of genetic fetal disease, and diagnostic examination of the fetal genetic material obtained by invasive procedure (chorionic villus sampling or amniocentesis) was indicated. A total of 31.3% of them (113/ 361) refused the invasive procedure and 2.5% (9/ 361) did not attend the planned procedure; the invasive procedure was performed in 66.2% (239/ 361). CONCLUSION: Comparing the results of CD and GD fetal screening in our medical facility with other specialized medical facilities in the Czech Republic is currently difficult to do, but information from the NRRH could allow objective and transparent comparisons in the future.

Transabdominal amniocentesis in expectant management of preterm premature rupture of membranes: A single center prospective study.

AIMS: The aim of this study was to evaluate the role of IL-6 point-of-care test in amniotic fluid obtained from serial amniocentesis in expectantly managed women with PPROM between 24 and 34 weeks of gestation. METHODS: We conducted a prospective observational cohort study which included 62 pregnant women with PPROM in gestational weeks between 22+0 and 34+0. Women aged >18 years were eligible if they presented with PPROM and a singleton pregnancy. Only women who delivered at >24.0 weeks were included in the study. In all women, the maternal blood sampling and a transabdominal amniocentesis were performed at the time of admission prior to the administration of corticosteroids, antibiotics, or tocolytics, to rule out signs of chorioamnionitis. Maternal temperature, maternal serum C-reactive protein (CRP) and white blood cell (WBC) counts were assayed every subsequent day until delivery. Amniotic fluid was used for the clinical assessment (IL-6 point-of-care test, identification of microorganisms in the amniotic fluid. After one week of expectant management of PPROM, second amniocentesis with amniotic fluid sampling was performed in patients who did not deliver. For all newborns, medical records regarding neonatal morbidity and mortality were reviewed. RESULTS: In total, 62 women aged 19 to 41 years were recruited in the study. The mean gestational age at the time of PPROM was 31+0, the mean gestational age at labor was 32+1, and the median time from PPROM to childbirth was 112 h. IL-6 point-of-care test values above 1,000 pg/mL (positive Il-6 AMC) were found in 12 women (19.4%) with median interval from PPROM to childbirth 56 h (min-max: 6.4-288). IL-6 point-of-care test values below 1,000 pg/mL (negative Il-6 AMC) were found in 51 women (81.0%). The neonatal mortality rate was 1.9% and was associated with prematurity. CONCLUSION: The major clinical finding of our study is that serial transabdominal amniocentesis with Il-6 point-of-care test helps to identify a high inflammatory status in amniotic fluid in women with PPROM. Subsequent expectant management of women with PPROM does not lead to worsening of short-term neonatal outcomes.

The association between mode of birth delivery and attention-deficit/hyperactivity disorder: a systematic review protocol of epidemiological evidence.

Caesarean section is currently the most frequently performed intervention after episiotomy in obstetrics and one of the most common abdominal operations overall. Rates of caesarean section have been rising globally. Given the increasing rate worldwide it is therefore necessary and important to understand how caesarean section affects child development. Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioural disorder in children. ADHD is characterized by a combination of symptoms including inattention, impulsivity and hyperactivity. Caesarean section may affect psychological development through changes in microbiota or stress response, and birth by caesarean section can be associated with a small increased risk of ADHD. In the current literature, there is no systematic review or protocol of the systematic review answering the question of whether the mode of delivery has influence on the risk of ADHD development.The objective of this review is to synthesize the best available evidence regarding the epidemiological association between the mode of delivery (caesarean section versus vaginal delivery) as exposure and ADHD as the outcome.A three-step strategy will be utilized in this review, aiming to find both published and unpublished studies. The initial search will be conducted using the MEDLINE, CINAHL and EMBASE. The second search will involve 21 databases and sources. Following the Preferred Reporting Items for Systematic Review and Meta-analysis statement analysis of title, abstracts and full texts, critical appraisal and data extraction will be carried out on selected studies using standardized instruments developed by Joanna Briggs Institute. All steps will be performed by two independent reviewers. If possible, statistical meta-analysis using Joanna Briggs Institute within the System for the Unified Management, Assessment and Review of Information will be pooled. Statistical heterogeneity will be assessed.The results will be disseminated by publishing in a peer-reviewed journal. Ethical assessment is not needed - we will search/evaluate the existing sources of literature.

The role of nCD64 in the diagnosis of neonatal sepsis in preterm newborns.

BACKGROUND: Diagnosing neonatal sepsis is difficult, particularly in preterm newborns. A promising method appears to be evaluation of cell surface markers by flow cytometry. METHODS: This prospective study investigated 217 newborns suspected of having early- or late-onset neonatal sepsis. In all, flow cytometry was used to determine the proportion of CD64-positive neutrophils (nCD64). Based on the clinical course and laboratory test results, newborns were categorized as having proven, possible, clinical or no neonatal sepsis. Subsequently, associations between the categories and nCD64 values were analyzed. RESULTS: There were significant associations between nCD64 values and the development of sepsis in newborns with both early- or late-onset sepsis. CONCLUSION: nCD64expression is significantly elevated in preterm newborn with early and late onset sepsis. The results show that nCD64 is a reliable marker for diagnosing neonatal sepsis.

Bilateral position-related ulnar neuropathy at elbow in pediatric population and review of the literature.

Perioperative ulnar neuropathies attributed to inappropriate arm positioning and padding during surgical procedures are commonly found in adults. However, their extremely rare incidence in the pediatric population may cause absent awareness of the risk of nerve injury in anesthetized pediatric patients. Furthermore, young patients respond to conservative treatment of neuropathy less favorably than adults and their response also depends on the pathomechanism of the ulnar nerve injury. A surgeon's or anesthetist's failure to recognize all of these specifics in children may result in substantial morbidity of young patients leading to lawsuits. Fortunately, with an adequate knowledge of surgical anatomy and types of procedures and positions in which the ulnar nerve is particularly vulnerable, and familiarity with measures to minimize the potential for neuropathy, this serious complication can be prevented. The aims of this review are to highlight personal experience and current knowledge of the rare position-related ulnar neuropathy, both from a clinical and anatomical-pathophysiological perspective, and to raise awareness about this rare but serious complication in the pediatric population.

Kinematic analysis of preterm newborns' spontaneous movements for postural activity assessment.

AIMS: The objectives of this pilot study were to assess the potential use of 3D videography for analyzing the motion of the body center of mass (COM) in newborns and to determine differences in spontaneous movements between preterm and full-term infants. METHODS: The group comprised 10 preterm newborns (gestational age at birth between 26 and 37 weeks; birth weight 800 to 2960 g; gestational age at the time of examination 34 to 39 weeks) and 10 full-term infants (gestational week 38 to 41; birth weight 2810 to 4360 g). To determine the range of motion of the COM, 3D videography was used (2 cameras, 25 Hz). When recording their movements, the infants were in the supine position, calm and awake. The recordings were processed using the APAS software. Selected points on the body were marked to obtain data for calculating the basic parameters of COM trajectories. RESULTS: The range of motion of the COM in both craniocaudal and anteroposterior directions was significantly greater in premature infants (P < 0.05 and P < 0.01, respectively) than in full-term babies. The variability of motion of the COM was significantly greater in the craniocaudal (P < 0.01) and anteroposterior (P < 0.05) directions in preterm babies. This was also valid for the velocity of motion of the COM in the craniocaudal direction (P < 0.05). CONCLUSIONS: 3D videography can be used for experimental assessment of motor behavior in preterm infants. Basic kinematic characteristics of the motion of the COM (range, variability, velocity) are greater in preterm infants.

Diagnostic accuracy of postnatal ultrasound screening for urinary tract abnormalities.

The study was aimed at (1) the determination of the incidence of abnormalities of the urinary tract in newborn infants detected by postnatal ultrasound screening, and (2) the evaluation of the diagnostic accuracy of postnatal ultrasound screening for detecting surgical urinary tract abnormalities. The prospective study was of full-term neonates born in the University Hospital of Olomouc in 2005-2008 who underwent renal ultrasound screening after 72 h of life. Significant findings were recorded. Subsequent diagnostic and therapeutic procedures were recorded and evaluated in a group of children with detected renal pelvic dilatation (RPD). (1) A total of 6,088 newborn infants was examined. The absolute and relative RPD incidence rates (anteroposterior diameter, APD) were as follows: 5-7 mm, 146 (2.4%); 7-10 mm, 70 (1.15%); 10-15 mm, 13 (0.21%), and 15 mm or more, 5 (0.08%). Of those, 16 children were operated on for abnormalities of the urinary tract, of which nine (56%) had been detected by prenatal screening. Other findings: six cases of unilateral renal agenesis, four cases of multicystic renal dysplasia, four of renal dystopia, one of polycystic kidney disease and one of renal hypoplasia. (2) A group of 224 children with postnatally detected RPD was examined, of whom 40 (17.9%) underwent voiding cystourethrography and/or scintigraphy and 16 (7.1%) were treated surgically. The receiver operating characteristic curves were analyzed, and the areas under the curves were calculated. Postnatal renal ultrasound screening is probably a suitable test for detecting significant urinary tract abnormalities.

Chronic smoking and its effect on arterial stiffness.

AIMS: The goal of this study was to investigate the effect of chronic smoking on arterial stiffness at a peripheral site using pulse wave analysis. METHODS: Forty two non-smokers (17 males, 25 females) of average age 20.2 +/- 1.3 year and forty five smokers (19 males, 26 females) of average age 24.3 +/- 2.4 year were included in the study. Four parameters, SI (stiffness index), RI (reflection index), CT (crest time) and IWD (interwave distance) were evaluated by means of an adapted device based on pletysmographic principles that transform volume changes to voltage changes. RESULTS: SI corresponding to pulse wave velocity was 0.64 m/s higher in smokers than in non-smokers (7.25 +/- 0.53 m/s versus 7.89 +/- 0.73 m/s, P < 0.001). RI was significantly higher in smokers (42.49 +/- 6.71 %, versus 35.46 +/- 0.06 %, P < 0.001) than in non-smokers. IWD for non-smokers was 8.01 +/- 0.13 %, in smokers we found a 16 % increase to 9.21 +/- 0.83 % (P < 0.001). We detected a small increase in CT in smokers compared to non-smokers (0.09 +/- 0.01 s versus 0.10 +/- 0.01 s, P < 0.005). CONCLUSIONS: Chronic tobacco smoking is associated with endothelial dysfunction. In smokers we found increased values for all assessed parameters. Our results suggest that the negative effect of cigarette smoking on the vascular system can be found even in young smokers who have been smoking for less than 10 years.

Pulse wave variability within two short-term measurements.

BACKGROUND: Pulse wave analysis permits non-invasive assessment of indices of arterial elasticity. Decreased arterial elasticity results in higher pulse wave velocity and therefore earlier wave reflection. AIM: The aim of this study was to evaluate the short-term variability for measurement of surface arteries. METHOD: For detection of artery wall movement, a plethysmography method was used. The changes in artery volume, affecting the fluid behind the scanning membrane, transfer themselves into pressure changes and move towards the positive input of a sensitive differential pressure transducer. The output is carried to a notebook computer and analysed within the frequency and time domain. To correlate arterial pulse waves, the following parameters were used: relative crest time RCT, interwave distance IWD, dicrotic wave amplitude DWA and dicrotic wave time DWT. These parameters were analysed using Bland-Altman plots. RESULTS: Two data points (5.6 %) fall outside the 2*SD range for both IWD and DWA parameters on posterior tibial artery and one data point (2.8 %) for DWT. Three data points (8.3 %) fall outside the 2*SD range for IWD and two data points for both DWA and DWT on the radial artery. Two data points fall outside the RCT measured on the ulnar artery, and all but one for IWD, DWA and DWT lie within the 2*SD range. CONCLUSIONS: Pulse wave analysis showed reproducibility in a short-term study of all three measured distal arteries and is therefore suitable for use in patients for observing the progression of artery-wall-involving diseases.

A contribution to sonograph image quality estimation using point spread function.

In medical sonography, sonograph image quality is an essential aspect for the safety of both patient and doctor. Its evaluation therefore requires an accurate and objective method for measurement. In this regard, a number of methods are in current use. Most of these are based on tissue mimicking phantom imaging. In contrast, we have used another principle based on Point Spread Function (PSF) analysis which is a product of the measuring system we have developed. In this case, the measured sonograph scans a small metallic ball target that moves in a water bath on a specified trajectory. The Region Of Interest (ROI) of the sonogram containing the ball target picture is digitised and the amplitude of the pixels analysed. The result is the PSF from which we calculate the lateral resolution (LR). For this purpose, we use our own original software. Using this method, we have to date been able to plot LR characteristics over the scanning plane. The method allows us to differentiate separate scanning lines and even multiple focal areas for dynamic focussing systems. It can detect malfunctions in dynamic focussing, size of aperture, time gain compensation function and/or transducer element failure. The procedure itself is not as easy or as fast to use as tissue mimicking phantoms or 3D signal to noise ratio evaluation, but it provides accurate and objective numeric parameters corresponding to the quality of image at any specified point over the whole scanning area. It is also a very powerful tool when used in combination with the other methods mentioned above.

Surface artery volume pulse wave measurement - verification of a new method.

The aim of this paper is to prove the possible reproducibility of measurement with a new developed device for artery elasticity monitoring and determining the standard of major pulse wave parameters. As a measurement sensor, a conic probe with thin convex membrane was used. This technique allows setting an arbitrary pressure to a measured surface artery. We measured pulse waves on the radial arteries of 108 individuals. We expected similar features in arterial wall elasticity. We concentrated primarily on the amount of subcutaneous fat. For the measured waves we evaluated five following pulse wave parameters: relative crest time, elasticity index, dicrotic wave attenuation, dicrotic wave time and interwave distance. There were no significant differences in measured pulse wave parameters among the tested groups of subjects.