Evaluation of Possible Side Effects in the Treatment of Urinary Incontinence with Magnetic Stimulation.

Background and Objectives: Magnetic stimulation is a type of conservative treatment of urinary incontinence. Our aim was to evaluate the possible side effects of this method. Materials and Methods: We conducted a systematic literature review. The key search terms were urinary incontinence, magnetic stimulation, and female. All known synonyms were used. Results: 255 titles and abstracts were retrieved, and 28 articles met our inclusion criteria. Out of 28 studies, 15 reported no side effects, five reported side effects, and eight did not report anything. There was no significant difference in the incidence of side effects between the sham and active treatment groups. Conclusions: Side effects of magnetic stimulation in comparison to other active treatments are minimal and transient. Among the conservative UI treatment methods, magnetic stimulation is one of the safest methods for the patient and as such a suitable first step in treating UI.

Magnetic stimulation in the treatment of female urgency urinary incontinence: a systematic review.

INTRODUCTION AND HYPOTHESIS: This systematic review analyzes published studies about magnetic stimulation (MS) treatment for UUI and determines whether this treatment is effective and non-invasive. METHODS: A systematic literature search was conducted using PubMed, the Cochrane Library, and Embase. The international standard for reporting results of systematic reviews and meta-analyses (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to guide the methodology of this systematic review. The key search terms were as follows: "magnetic stimulation" and "urinary incontinence." We limited the time frame to articles published from 1998, when the FDA approved MS as a conservative treatment option for UI. The last search was performed on 5 August 2022. RESULTS: Two authors independently reviewed 234 article titles and abstracts, of which only 5 fitted the inclusion criteria. All 5 studies included women with UUI, but every study had different diagnostic and entry criteria for patients. They also differed in their treatment regimens and methodological approaches to assessing the efficacy of treating UUI with MS, which made it impossible to compare the results. Nonetheless, all five studies established that MS is an effective and non-invasive way of treating UUI. CONCLUSIONS: The systematic literature review led to the conclusion that MS is an effective and conservative way of treating UUI. Despite this, literature in this area is lacking. Further randomized controlled trials are needed, with standardized entry criteria, UUI diagnostics, MS programs, and standardized protocols to measure the efficacy of MS in UUI treatment, with a longer follow-up period for post-treatment patients.

Regional citrate anticoagulation for continuous renal replacement therapy in newborns and infants: Focus on citrate accumulation.

Continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in newborns and infants is challenging and accumulation of citrate can occur. There are only a few studies reporting the detailed data on RCA. We aimed to analyze RCA-CRRT at our institution with focus on citrate accumulation. Critically ill newborns and infants up to 11 kg of body weight (BW), treated with RCA-CRRT in the 2011-2016 period were included in this retrospective observational study. Prismaflex(R) and Multifiltrate-CiCa(R) dialysis monitors were used with either automated or manual RCA. Data was collected regarding the circuit lifetime, parameters of RCA, markers of citrate accumulation (total/ionized calcium ratio > 2.5), and metabolic complications. We included 10 children with mean age of 2.6 ± 3.8 months and BW of 4.6 ± 2.7 kg. In-hospital mortality was 60%. RCA-CRRT parameters were: blood flow 46 ± 9 mL/min (12 ± 5 mL/min/kg BW), citrate dose 2.8 ± 0.6 mmol/L of blood resulting in estimated citrate load to the patient of 1.7 ± 0.8 mmol/h/kg BW. In total, 57 dialysis circuits were used with mean filter lifetime of 39 ± 29 h. Citrate accumulation (total/ionized calcium ratio > 2.5) was observed in 7/10 patients and in 14/57 (25%) of circuits; those circuits were performed in children with lower age and BW, had higher relative blood flow and citrate load, while citrate dose was similar. When citrate load to the patient was used to predict citrate accumulation, AUC under the ROC curve was 0.78 and 1.7 mmol/h/kg BW was considered the optimal cutoff value (sensitivity 71% and specificity 72%). CRRT with RCA using equipment, developed for adult population, is feasible in newborns and infants. Signs of citrate accumulation developed relatively often. To prevent it, we suggest avoiding citrate loads above 1.7 mmol/h/kg BW, which can best be achieved by keeping the blood flow below 9 mL/min/kg BW.

Neutrophil CD64 index in cerebrospinal fluid as a marker of bacterial ventriculitis in children with external ventricular drainage.

BACKGROUND: Bacterial ventriculitis is a common complication in children with temporary external ventricular drains (EVD) and the diagnosis is challenging. The present study compared the diagnostic accuracy of novel cerebrospinal fluid (CSF) marker - CD64 expression on neutrophils measured as neutrophil CD64 index (CD64in) to routine laboratory CSF and blood markers for bacterial ventriculitis in children with EVD. METHODS: We conducted a prospective, observational study, enrolling children with EVD. CD64in in CSF together with CSF markers (leukocyte count, percentage of neutrophils, glucose, and proteins) and blood markers (leukocyte and differential count, C-reactive protein (CRP), and procalcitonin (PCT)) were studied at the time of suspected bacterial ventriculitis. CD64in was measured by flow cytometry. Diagnostic accuracy determined by the area under the receiver-operating characteristic (ROC) curves (AUC) was defined for each marker. RESULTS: Thirty-three episodes of clinically suspected ventriculitis in twenty-one children were observed during a 26-month period. Episodes were classified into those with microbiologically proven ventriculitis (13 episodes) and into those with microbiologically negative CSF (20 episodes). CD64in and leukocyte count were the only CSF markers that could differentiate between groups with diagnostic accuracy of 0.875 and 0.694, respectively. Among blood markers only CRP and band neutrophils differentiated between groups with diagnostic accuracy of 0.792 and 0.721, respectively. CONCLUSIONS: CD64in in CSF is a promising diagnostic marker of bacterial ventriculitis in children with EVD as it has higher diagnostic accuracy than routine blood and CSF markers for diagnosing bacterial ventriculitis at the time of clinical suspicion.

Sevoflurane sedation for weaning from mechanical ventilation in pediatric intensive care unit.

BACKGROUND: Light sedation is the prerequisite for weaning from mechanical ventilation. Our aim was to evaluate the technical feasibility and efficacy of sevoflurane delivered by anesthetic conserving device (ACD) for sedation of children during weaning from mechanical ventilation. METHODS: Prospective observational feasibility study in pediatric ICU. Patients who were identified as ready for weaning from mechanical ventilation and had Withdrawal Assessment Tool version 1 (WAT-1) score of ≥8 were switched from intravenous sedatives to sevoflurane sedation by AnaConDa® ACD (Sedana Medical, Danderyd, Sweden) placed at the inspiratory limb of the ventilator (INSP group) or at Y-piece (Y group). Primary endpoints were proportion of time within a predefined interval on a sedation scale (COMFORT score 17-26) and the time required from discontinuation of sevoflurane until extubation. Secondary endpoints were the short-term (-6 hours to +6 hours) effects on systemic hemodynamics. RESULTS: We enrolled 40 patients. Proportion of time with COMFORT score 17-26 was 89%, mean time to extubation was 10.2±3.9 min. The sevoflurane flow rate was 7±3 mL/h in INSP group, and 3.5±1.3 mL/h in Y group to obtain median end-tidal sevoflurane concentration (ETsevo) of 0.88 (range: 0.21-1.2) and 1.3 (range: 0.43-1.47) vol%, respectively. Mean arterial pressure (MAP) decreased significantly from 67.2±15 mmHg at -1 hour to 61±13.8 mmHg at +1 hour, and 62.8±14.8 mmHg at +6 hours, necessitating fluid therapy and/or vasopressor increase in eight (20%) patients. Transient psychomotor dysfunction developed in five (12.5%) patients after discontinuation of sevoflurane. CONCLUSIONS: Sevoflurane administration by ACD is technically feasible in critically ill children. It provides sedation within the desired sedation interval 89% of time, with short time to extubation after termination of administration. Decrease in mean arterial pressure warrants good hemodynamic monitoring and optimization of preload. Longer sevoflurane sedation and higher ETsevo is associated with development of reversible psychomotor dysfunction.