Urolitiasis en el embarazo: avances en las modalidades de imagen y evaluación de las tendencias actuales en los abordajes endourológicos / Urolithiasis in pregnancy: Advances in imaging modalities and evaluation of current trends in endourological approaches

Objetivo Dados los desafíos inherentes al diagnóstico y tratamiento de las mujeres embarazadas con urolitiasis, nos proponemos revisar las modalidades de imagen y el manejo endourológico actual de estas pacientes. Materiales y métodos se realizó una revisión de la literatura disponible sobre la urolitiasis en el embarazo. Esto incluyó la evaluación, el diagnóstico por imágenes y las opciones terapéuticas. Las bases de datos en las que se realizó la búsqueda fueron Google Scholar y PubMed. Se examinaron un total de 346 resúmenes. Tras aplicar los criterios de inclusión y exclusión quedaron 42 publicaciones: 18 estudios retrospectivos, 10 revisiones o metaanálisis, 8 conjuntos de directrices, 5 ensayos de control aleatorizados y una cohorte prospectiva. Resultados Iniciamos nuestra revisión con la literatura disponible sobre la seguridad y eficacia de las modalidades de imagen en la planificación quirúrgica de la urolitiasis en pacientes embarazadas. Esto incluye la ecografía renal, la radiografía abdominal, la tomografía computarizada y la resonancia magnética. Mientras que la tomografía computarizada puede suponer una exposición mayor a la radiación, con posibles problemas de seguridad, la resonancia magnética, aunque es una prueba menos sensible, parece ser más segura. A continuación se describen la seguridad, la eficacia y los resultados de diversas intervenciones quirúrgicas para la urolitiasis en pacientes embarazadas, como son la colocación de un stent ureteral, la nefrostomía percutánea, la ureteroscopia, la litotricia extracorpórea por ondas de choque y la nefrolitotomía percutánea. La ureteroscopia es un abordaje más seguro, pero la nefrolitotomía percutánea ofrece tasas mayores de ausencia de cálculos. Utilizando un enfoque basado en la evidencia, proponemos un algoritmo para el manejo de las mujeres embarazadas con cólico renal (AU)

Objective Given the challenges involved in diagnosis and treatment of pregnant women with urolithiasis, we aim to review the imaging modalities and current endourological management of these patients. Materials and methods We performed a review of the available literature on urolithiasis in pregnancy. This included evaluation, diagnostic imaging, and therapeutic options. The databases we searched from included Google Scholar and PubMed. A total of 346 abstracts were screened. After our inclusion/exclusion criteria were met, we were left with 42 sources: 18 retrospective studies, 10 reviews/meta-analyses, 8 sets of guidelines, 5 randomized control trials, and one prospective cohort. Results We begin our review with the literature available on the safety and efficacy of imaging modalities in the surgical planning for urolithiasis in pregnant patients. This includes renal ultrasound, abdominal x-ray, computed tomography scan, and magnetic resonance imaging. While computed tomography may result in an added radiation exposure, with possible safety concerns, magnetic resonance imaging seems to be safer, however a less sensitive test. We next describe safety, efficacy, and outcomes of various surgical interventions for urolithiasis in pregnant patients. This encompasses ureteral stenting, percutaneous nephrostomy, ureteroscopy, extracorporeal shock wave lithotripsy, and percutaneous nephrolithotomy. Ureteroscopy is a safer approach, but percutaneous nephrolithotomy offers higher stone-free rates. Using an evidence-based approach, we propose an algorithm for management of the pregnant women with renal colic. Conclusion Management of the pregnant women with suspected urolithiasis is a unique challenge for healthcare providers. A multi-disciplinary approach should be taken to optimize outcomes through an evidence-based approach (AU)

Urolithiasis in pregnancy: Advances in imaging modalities and evaluation of current trends in endourological approaches.

OBJECTIVE: Given the challenges involved in diagnosis and treatment of pregnant women with urolithiasis, we aim to review the imaging modalities and current endourological management of these patients. MATERIALS AND METHODS: We performed a review of the available literature on urolithiasis in pregnancy. This included evaluation, diagnostic imaging, and therapeutic options. The databases we searched from included Google Scholar and PubMed. A total of 346 abstracts were screened. After our inclusion/exclusion criteria were met, we were left with 42 sources: 18 retrospective studies, 10 reviews/meta-analyses, 8 sets of guidelines, 5 randomized control trials, and 1 prospective cohort. RESULTS: We begin our review with the literature available on the safety and efficacy of imaging modalities in the surgical planning for urolithiasis in pregnant patients. This includes renal ultrasound, abdominal x-ray, computed tomography scan, and magnetic resonance imaging. While computed tomography may result in an added radiation exposure, with possible safety concerns, magnetic resonance imaging seems to be safer, however a less sensitive test. We next describe safety, efficacy, and outcomes of various surgical interventions for urolithiasis in pregnant patients. This encompasses ureteral stenting, percutaneous nephrostomy, ureteroscopy, extracorporeal shock wave lithotripsy, and percutaneous nephrolithotomy. Ureteroscopy is a safer approach, but percutaneous nephrolithotomy offers higher stone-free rates. Using an evidence-based approach, we propose an algorithm for management of the pregnant women with renal colic. CONCLUSION: Management of the pregnant women with suspected urolithiasis is a unique challenge for healthcare providers. A multi-disciplinary approach should be taken to optimize outcomes through an evidence-based approach.

Bacteriophage applications: where are we now?

Bacteriophages are bacterial viruses and have been used for almost a century as antimicrobial agents. In the West, their use diminished when chemical antibiotics were introduced, but they remain a common therapeutic approach in parts of eastern Europe. Increasing antibiotic resistance in bacteria has driven the demand for novel therapies to control infections and led to the replacement of antibiotics in animal husbandry. Alongside this, increased pressure to improve food safety has created a need for faster detection of pathogenic bacteria. Hence, there has been a resurgence of interest in bacteriophage applications, and this has encouraged the emergence of a large number of biotech companies hoping to commercialize their use. Research in Europe and the United States has increased steadily, leading to the development of a range of applications for bacteriophage agents for the healthcare, veterinary and agricultural sectors. This article will attempt to answer the question of whether bacteriophages are now delivering on their potential.

Correlates of drug abuse in adolescents: A comparison of families of drug abusers with families of nondrug abusers.

This study was designed to compare drug-abusing adolescents and their families with nondrug-abusing adolescents and their families by (1) a comparison of the adolescents on measures of self-esteem and perceived parental behavior, (2) a comparison of the parents of drug-abusing adolescents with the parents of nondrug-abusing adolescents on child-rearing attitudes and on distortion in perceived parental behavior, and (3) an identification of the salient factors contributing to the prediction of drug-use in adolescents. The subjects in this study were 26 clinical inpatient drug-abusing adolescents and their parents and 26 nondrug-abusing adolescents and their parents. Testdata consisted of the adolescent's self-esteem score on the Self Esteem Inventory (SEI), the adolescent's factor score on the Child's Report of Parental Behavior Inventory-Revised (CRPBI-R), and the parents' scale score on each of the five factors of the Parent Attitude Survey (PAS). Findings indicate that the adolescent's self-esteem and perception of parental behavior, the ability of the parents to predict the child's parental perceptions, and the professed parental attitudes toward confidence and responsibility in child rearing all combine to suggest a set of factors differentiating the drug-abusing adolescent from the nondrug-abusing adolescent.