The long-term added value of voiding school for children with refractory non-neurogenic overactive bladder: an inpatient bladder rehabilitation program.

INTRODUCTION & BACKGROUND: Despite adequate management, 20% of children with overactive bladder (OAB) syndrome fail to improve their bladder function. To approach the need for alternative strategies, an inpatient bladder rehabilitation 'voiding school' program was established. OBJECTIVE: The objective of this study was to evaluate the short- and long-term (1-year follow-up) outcome of this voiding school program in children with refractory OAB. In addition, the authors aimed to identify which children achieved the best outcomes with this voiding school program. STUDY DESIGN: The charts of all children (n = 357, mean age: 9.7 ± 2.0 years, 63.6% boys) with refractory OAB who attended voiding school between 2000 and 2010 were reviewed. A linear mixed model with random intercept was used to evaluate the incontinence (expressed by enuresis and daytime incontinence voiding scores) and maximal voiding volume (MVV). RESULTS & DISCUSSION: This study demonstrated an overall beneficial long-term effect of the inpatient program on day- and night-time incontinence, in which 36.6% of children achieved dryness during day- and night-time. In addition, the mean overall decline in the number of wet nights and days declined with 4 extra dry days and/or nights per week, in comparison with the level of continence before attending the voiding school program. In contrast, only a temporary increase in MVV was seen, however, without relapse incontinence. At last, the authors identified the negative impact of decreasing age, male sex, dysfunctional voiding and nocturnal polyuria on the overall outcome of the inpatient program. CONCLUSION: An inpatient rehabilitation 'voiding school' program is a successful and safe treatment modality for children with refractory OAB that results in long-term significant increase of continence, as well as amelioration in degree of severity. The worst outcomes of this voiding school program were detected in children with young age, who were boys, or had associated nocturnal polyuria, dysfunctional voiding, and/or faecal incontinence.

Production and performance of bio-based mineral fertilizers from agricultural waste using ammonia (stripping-)scrubbing technology.

Development and optimization of nutrient recovery technologies for agricultural waste is on the rise. The full scale adoption of these technologies is however hindered by complex legal aspects that result from lack of science-based knowledge on characterization and fertilizer performance of recovered end-products. Ammonium sulfate (AS) and ammonium nitrate (AN), end-products of (stripping-)scrubbing technology, are currently listed by the European Commission as high priority products with the potential of replacing synthetic N fertilizers. The legal acceptance of AS and AN will be highly dependent on critical mass of scientific evidence. This study describes four different (stripping-)scrubbing pathways to recover ammonia with an aim to (i) assess product characteristics of ammonium nitrate (AN) and ammonium sulfate (AS) produced from different installations, (ii) evaluate fertilizer performance of recovered end-products in greenhouse (Lactuca sativa L.) and full field (Zea mays L.) scale settings and (iii) compare the observed performances with other published studies. Results have indicated that the recovered products might have a different legal status, as either mineral N fertilizer or yet as animal manure, depending on the used (stripping-)scrubbing process pathway. Nevertheless, no significant differences in respect to product characterization and fertilizer performance of AN and AS have been identified in this study as compared to the conventional use of synthetic N fertilizers. This indicates that recovered AS and AN are valuable N sources and therefore might be used as N fertilizers in crop cultivation.

Treatment of vaginal candidosis with oral ketoconazole.

Results with ketoconazole were studied in 281 non-pregnant patients with acute and chronic Candida-vaginitis. Several dose regimens were evaluated. The 5-day regimens (200 mg b.i.d. or 400 mg once daily) seem to be the most appropriate schedules in this infection. Side effects were minor. Relapse rates are not different from those, historically known, with topical antifungals.