RESUMO
PURPOSE: We evaluated bladder growth after combined bladder and epispadias repair in children 5 years or older, and correlated the histological findings with final surgical outcomes. MATERIALS AND METHODS: We prospectively evaluated 8 late bladder exstrophy referrals from a series of 26 patients treated during a 5-year period. Evaluated outcome measures were bladder capacity (expressed as percentage of expected bladder capacity for age), upper tracts status, continence and histological findings (collagen-to-smooth muscle ratio and type III-to-total collagen ratio). Data were analyzed using nonparametric Spearman rank correlation coefficient and Mann-Whitney U test. RESULTS: Mean age at combined bladder and epispadias repair was 8.9 years. Volitional voiding with a mean ± SD bladder capacity of 90 ± 7.48 ml was achieved in all patients except 1 with a suprapubic fistula. However, mean ± SD bladder capacity was 33.1% ± 7.47% of expected bladder capacity, and was inversely proportional to age at surgery. Mean ± SD compliance and pressure specific bladder volume less than 20 cm H2O were 13.86 ± 4.97 ml/cm H2O and 69.29 ± 18.07 ml, respectively. Two patients had nonobstructive hydroureteronephrosis with bilateral polar scarring. Mean ± SD collagen-to-smooth muscle and type III-to-total collagen ratios were 2.96 ± 1.062 and 0.4 ± 0.106, respectively. The latter showed a significant negative correlation to bladder compliance (p = 0.025). CONCLUSIONS: Successful anatomical closure stimulates bladder growth, even in cases of late referral. However, due to histological alterations, these bladders are poorly distensible and noncompliant. Thus, to have an acceptable functional outcome with preserved upper tracts, augmentation cystoplasty is needed in cases of late referral.
Assuntos
Extrofia Vesical/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Bexiga Urinária/cirurgia , Urodinâmica/fisiologia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Extrofia Vesical/patologia , Extrofia Vesical/fisiopatologia , Criança , Pré-Escolar , Cistoscopia , Diagnóstico Tardio , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária/patologia , Bexiga Urinária/fisiopatologiaRESUMO
BACKGROUND: Management of the disease symptomatology impacts the long-term functioning and quality of life (QOL) in psychotic patients. AIM: The aim of this research was to study the association between psychiatric symptoms (positive, negative and general psychopathology symptoms) and QOL in first-episode schizophrenia patients. METHODS: Fifty-five first-episode drug-naïve schizophrenia outpatients were recruited from a tertiary care hospital in New Delhi, India. WHOQOL-Bref (World Health Organization Quality of Life) Scale was used to assess multi-dimensional domains of QOL (physical, psychological, social and environmental health). The patients were evaluated clinically using PANSS and followed up for 6 months. Multivariate analyses were carried out to outline the symptoms which are predictive of QOL in these patients. RESULTS: Physical well-being as assessed with WHOQOL-Bref is significantly impacted by the positive, negative and general psychopathology symptoms of the disease. General psychopathology symptoms demonstrated a strong relationship with different facets of QOL. These symptoms are predictive of physical (P=0.025) and psychological health (P=0.026), social relationships (P=0.009) and environmental QOL (P=0.022). CONCLUSIONS: The general psychopathology symptoms significantly impact QOL in a diverse manner. Negative symptoms have a greater influence than positive symptoms on subjective QOL. CLINICAL IMPLICATIONS: The antipsychotics focus on primary positive and negative disease symptoms. There is a need to develop a holistic approach (target non-psychotic symptoms intensively) in the disease management to prevent further long-term impairment of QOL.
Assuntos
Qualidade de Vida , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Adulto , Antipsicóticos/uso terapêutico , Feminino , Humanos , Masculino , Análise Multivariada , Pacientes Ambulatoriais , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Adulto JovemRESUMO
BACKGROUND: Epilepsy is a chronic disorder that significantly affects learning and behavior. Children with epilepsy are much more vulnerable for educational problems than with any other chronic illness. OBJECTIVES: The study was conducted to assess the extent of educational problems and factors associated with educational underachievement in Indian children with epilepsy. METHODS: It was a case control study and included 100 cases of 6-16 years age of epilepsy, 50 healthy children (control A) and 50 children with persistent asthma (control B). Their demographic and disease variables were evaluated. The educational performance was assessed by using a predesigned semi structured open ended questionnaire to parents and by teacher's report. Psychological evaluation was done in first step by using a standard questionnaire, childhood psychopathology measurement schedule. In second step, those have shown poor educational performance or significant score in standard questionnaire underwent detailed psychiatric evaluation. RESULTS: Educational problems were reported in cases (36%), control A (2%) and control B (16%). Demographic or disease variables were not associated with educational problems in cases except that boys were more affected than girls. On psychiatric evaluation psychopathological illnesses (47%) like attention deficit hyperkinetic disorder, conduct disorder and depression were found to be commonly associated with poor educational performance (47%) followed by decreased learning opportunities (22.2%) and borderline intelligence (19.4%) in children with epilepsy. CONCLUSION: Educational problems are commoner in children with epilepsy than with asthma. Psychopathological problems are commonly associated with educational underachievement in children with epilepsy. Therefore periodic psychosocial assessment, counseling and support must be provided to improve the psychosocial adjustment in children with epilepsy.
Assuntos
Escolaridade , Epilepsia/complicações , Epilepsia/psicologia , Deficiência Intelectual/complicações , Transtornos Mentais/complicações , Baixo Rendimento Escolar , Adolescente , Asma/psicologia , Estudos de Casos e Controles , Criança , Avaliação Educacional , Epilepsia/fisiopatologia , Feminino , Humanos , Índia , MasculinoRESUMO
BACKGROUND: Olanzapine associated weight gain (WG) is a major concern in patients with schizophrenia. The purpose of this study was to assess the efficacy of topiramate to prevent olanzapine induced WG in these cases. We also studied various metabolic parameters. METHODS: In this 12-week, double-blind, parallel group study, seventy-two drug-naïve, first-episode schizophrenia patients were randomized to receive olanzapine+placebo (olanzapine group) or olanzapine+topiramate (100mg/day) (topiramate group). Weight, body mass index, fasting glucose, insulin, insulin resistance (IR), leptin, lipids and blood pressure were assessed at baseline and at 12 weeks. The patients were clinically evaluated using Positive and Negative Syndrome Scale (PANSS) and were monitored for adverse effects. RESULTS: Topiramate resulted in a weight loss of 1.27+/-2.28 kg (p<0.01), decrease in leptin (p<0.001), glucose, cholesterol, triglyceride levels and systolic and diastolic blood pressure. In the olanzapine group, there was a significant WG, hyperglycemia, hyperinsulinemia, increased IR, hyperleptinemia, hypercholesterolemia and hypertriglyceridemia (p<0.001).There was a greater clinical improvement (PANSS scores) (p<0.001) in the topiramate group. The adverse effects were well tolerated. CONCLUSIONS: Topiramate could prevent olanzapine induced weight gain and adverse metabolic effects. It also results in a greater clinical improvement when used with olanzapine in schizophrenia.
Assuntos
Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Frutose/análogos & derivados , Doenças Metabólicas/induzido quimicamente , Doenças Metabólicas/prevenção & controle , Fármacos Neuroprotetores/uso terapêutico , Aumento de Peso/efeitos dos fármacos , Adolescente , Adulto , Idoso , Glicemia/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Índice de Massa Corporal , Colesterol/sangue , Método Duplo-Cego , Feminino , Frutose/uso terapêutico , Humanos , Insulina/sangue , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Olanzapina , Estudos Prospectivos , Esquizofrenia/tratamento farmacológico , Topiramato , Adulto JovemRESUMO
OBJECTIVE: This study compared the efficacy and safety of oxcarbazepine and divalproex sodium in acute mania patients. SUBJECTS AND METHODS: In this 12 week, randomized, double-blind pilot study, 60 patients diagnosed with acute mania (DSM-IV) and a baseline Young Mania Rating Scale (YMRS) score of 20 or more received flexibly dosed oxcarbazepine (1,000-2,400 mg/day) or divalproex (750-2,000 mg/day). The mean decrease in the YMRS score from baseline was used as the main outcome measure of response to treatment. A priori protocol-defined threshold scores were