Urinary tract infection (UTI) is one of the most common infectious diseases in the pediatric population and represents a major cause of antibiotic consumption and hospitalization in children. ...Considering the ongoing controversies on the management of pediatric UTI and the challenges due to increasing antimicrobial resistance, the aim of the present study was to evaluate the level of agreement on UTI management in pediatric age in Emilia-Romagna Region, Italy, and to assess on the basis of recent studies whether there is the need to change current recommendations used by primary care pediatricians, hospital pediatricians, and pediatric surgeons in everyday clinical practice to possibly improve outcomes. This consensus provides clear and shared indications on UTI management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date collection of statements on procedures to follow for pediatric UTI, in order to guide physicians in the management of the patient, standardize approaches, and avoid abuse and misuse of antibiotics. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best therapeutic management in cases with antimicrobial resistance and real usefulness of long-term antibiotic prophylaxis.
Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term ...complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs.
A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology.
The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended.
Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.
Fungal infections are diagnosed increasingly often in patients affected by hematological diseases and their mortality has remained high. The recent development of new antifungal drugs gives the ...clinician the possibility to assess the combination of antifungal drugs with in-vitro or in animal-model synergistic effect.
We analyzed retrospectively the safety and efficacy of caspofungin-based combination therapy in 40 children and adolescents, most of them were being treated for a malignant disease, who developed invasive aspergillosis (IA) between November 2002 and November 2005.
Thirteen (32.5%) patients developed IA after hematopoietic stem cell transplantation (HSCT), 13 after primary diagnosis, usually during remission-induction chemotherapy, and 14 after relapse of disease. Severe neutropenia was present in 31 (78%) out of the 40 patients. IA was classified as probable in 20 (50%) and documented in 20 (50%) patients, respectively. A favorable response to antifungal therapy was obtained in 21 patients (53%) and the probability of 100-day survival was 70%. Different, though not significant, 100-day survival was observed according to the timing of diagnosis of IA: 51.9% after HSCT; 71.4% after relapse; and 84.6% after diagnosis of underlying disease, p 0.2. After a median follow-up of 0.7 years, 20 patients are alive (50%). Overall, the combination therapy was well tolerated. In multivariate analysis, the factors that were significantly associated to a better overall survival were favorable response to antifungal therapy, p 0.003, and the timing of IA in the patient course of underlying disease, p 0.04.
This study showed that caspofungin-based combination antifungal therapy is an effective therapeutic option also for pediatric patients with IA. These data need to be confirmed by prospective, controlled studies.
Provides a comprehensive and detailed review of pathogenesis, laboratory, and clinical presentation of tumor lysis syndrome together with clinical studies already performed both in paediatric and ...adult patients. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
In human addicts, craving and relapse are frequently evoked by the recall of memories connected to a drug experience. Established memories can become labile if recalled and can then be disrupted by ...several interfering events and pharmacological treatments, including inhibition of protein synthesis. Thus, reactivation of mnemonic traces provides an opportunity for disrupting memories that contribute to pathological states. Here, we tested whether the memory of a drug experience can be weakened by inhibiting protein synthesis after the reactivation of its trace. We found that an established morphine conditioned place preference (mCPP) was persistently disrupted if protein synthesis was blocked by either anisomycin or cycloheximide after the representation of a conditioning session. Unlike other types of memories, an established mCPP did not become labile after contextual recall, but required the concomitant re-experience of both the conditioning context and the drug. An established mCPP was disrupted after the conditioning session if protein synthesis was blocked selectively in the hippocampus, basolateral amygdala, or nucleus accumbens but not in the ventral tegmental area. This disruption seems to be permanent, because the preference did not return after further conditioning. Thus, established memories induced by a drug of abuse can be persistently disrupted after reactivation of the conditioning experience.
Introduction: High dose BUS is an important component of pre-transplant conditioning regimen in children with advanced hematological malignancies or solid tumor undergoing allogeneic or autologous ...stem cell transplantation. Variable intra and inter systemic drug exposure as measured by area under curve (AUC), can occurs following oral administration and may be influenced by age, body weight, absorption variability and, particularly in infants, by difficulties to assumption.
Aims: to compare the PK, the toxicity and the compliance of iv versus oral BUS administration in children undergoing pre-transplant conditioning regimen.
Patients and methods: 12 patients (pts), median age 37 (7–177) mos, body weight 6–69 kg, affected by AML (3), ALL (4), NB (3), Thalassemia (2), undergoing to autoSCT (4) or alloSCT (8), received as preparative regimen oral BUS at the dose of 1 mg/kg every 6 hours for a total of 16 doses (6 pts, GR1), or 2 hours i.v. infusion of BUS at the dose of 0.8 mg/kg every 6 hours for a total of 16 doses (6 pts, GR2). Four out of 6 GR1 pts (7–30 mos) had a nasogastric radiolus to allow BUS assumption. PK studies were performed after the first dose of BUS on blood samples collected at 0, 1, 2, 4, 6 hours after first administration in GR1 and at 0, 2, 3, 4, 6 hours from the beginning of the first infusion in GR2. BUS plasma level was determined by high-performance liquid chromatography as described by Henner et al.
Results: GR were comparable as for age (p= 0.07) and body weight (p= 0.14). Comparison of PK median values (+SD) in GR1 versus GR2 didn't highlighted statistically significant differences as for AUC (p= 0.20) and for T1/2 (p= 0.11). Peak concentration was higher in GR2 (p= 0.058). Bioavailability was 0.61. Variation factor (VF%) were constantly low in GR2. No pt showed acute or late treatment-related extra-medullary toxicity and all pts developed a rapid and sustained hematopoietic recovery.
Conclusions: systemic exposure to 0.8 mg/kg iv BUS versus 1 mg/kg oral BUS is overlapping. Low VF% highlight a smaller interpatient variability in exposure compared to oral BUS. Moreover allows to avoid assumption difficulties in younger pts.
An extensive rearing system (ERS) for poultry requires an outdoor run, which enhances the foraging activity of chickens. Slow-growing (SG) strains are more adapted to ERS than fast-growing (FG); and ...generally, have higher levels of bioactive compounds in their meat. The aim of this paper was to assess the storage efficiency of n-3 and n-6 polyunsaturated fatty acids (PUFA), tocols and carotenes in the meat of seven commercial SG genotypes (SG1-7). One hundred SG chicks/strain of both sexes were included and their walking activity (High- or Low-W) was classified: SG1-4, HW comprised more than 10% of the time budget, and SG5-7, less than 10% (LW). Chickens were reared in pens (4 pens/strain) with indoor (0.10 m
2
/bird) and outdoor (4 m
2
/bird) areas, and they were fed the same diet
ad libitum
(starter feed for 1–21 d, grower feed from 22 d to slaughter at 81 d). The chickens were weighed weekly; feed consumption and grass intake were also estimated. At 81 days of age, 32 chickens/genotype were selected on the basis of the average weight (1:1, M:F) and slaughtered. The breast, thigh and drumstick meat were excised from 30 carcasses/genotype, sampled and stored at -20°C until analysis. Nutrients (e.g., n-3, n-6, carotenes and tocols) of feed, grass and meat were analyzed. The storage efficiency of nutrients was estimated as the ratio between the amount deposited in the body muscles (OUT) and the dietary intake (feed and grass, IN). The genotype affected chickens foraging behavior and the intake of nutrients. For SG1, SG2 and SG3, more than 50% of the intake of n-3 came from grass, whereas in the other genotypes, less than 20%. Accordingly, chickens that foraged more showed better meat nutritional profiles (less fat, more n-3 and antioxidants), which, in ERS, was ascribed to grass ingestion. However, the storage efficiency of nutrients into meat was inversely correlated with the grass intake: strains with higher grass intake (SG1, SG2, and SG3) had lower storage rates. Several hypotheses were proposed to explain these trends.
Abstract
The use of the scan-sampling method, especially when a large amount of data is collected, has become widespread in behavioral studies. However, there are no specific guidelines regarding the ...choice of the sampling interval in different conditions. Thus, establishing a standard approach for video analysis represents an important step forward within the scientific community. In the present work, we hypothesized that the length of the sampling interval could influence the results of chicken behavioral study, for which we evaluated the reliability, accuracy, and validity of three different sampling intervals (10, 15 and 30 min). The Bland–Altman test was proposed as an innovative approach to compare sampling intervals and support researcher choices. Moreover, these sampling intervals were applied to compare the behavior of 4 chicken genotypes kept under free-range conditions. The Bland–Altman plots suggested that sampling intervals greater than 10 min lead to biases in the estimation of rare behaviors, such as “Attacking”. In contrast, the 30-min sampling interval was able to detect differences among genotypes in high-occurrence behaviors, such as those associated with locomotory activity. Thus, from a practical viewpoint, when a broad characterization of chicken genotypes is required, the 30-min scan-sampling interval might be suggested as a good compromise between resources and results.
PDF
