PubMed Health⌕ Search

Biomedical subjects

J van der Voort

Publications and source records attributed to J van der Voort.

4 recordsLinked to original sources
PubMed1997

The struggle to diagnose UTI in children under two in primary care.

BACKGROUND: The incidence of urinary tract infection (UTI) in childhood is highest in infancy and accounts for 5% of febrile infants. Reflux nephropathy following UTI in early childhood is the commonest preventable cause of chronic renal failure. Recent guidelines aim to improve the diagnosis and management of UTI in small children. OBJECTIVES: To assess management of febrile children and UTI in children under 2 years amongst GPs, and to identify some reasons for the difficulties in diagnosing UTI. METHOD: Questionnaire distributed by periodical journal. RESULTS: Eighty-two GPs responded, of whom 61 (74%) were unaware of the recent Royal College of Physicians guidelines on childhood UTI. Seventy-seven GPs (94%) would find guidelines helpful on when to send a urine sample for culture from a child under 2 years. Only 11 GPs (14%) regularly sent urine from febrile infants and toddlers; 48 GPs (63%) sent urine from only 0-10% of patients; 21 (26%) were unable to collect urine at all from these children. Several difficulties were identified by GPs regarding investigation for UTI in children. These related to practical difficulties in urine collection and culturing, lack of professional awareness of the importance of UTI and concerns about the costs of investigation. CONCLUSION: GPs frequently do not investigate for UTI in febrile children due to practical difficulties, lack of awareness and financial costs. National guidelines need to be disseminated and implemented effectively to reach target groups. Further scope for research into a simple, cheap method to collect and test urine has been highlighted as a priority to improve early diagnosis of UTI. Management of UTI in primary care can be improved with carefully evaluated strategies and this could lead to a reduction in the prevalence of renal scarring.

Family Practice↗
PubMed1997

A urine analysis method suitable for children's nappies.

BACKGROUND: Urinary tract infection in infancy continues to be underdiagnosed, despite its association with renal scarring and thus hypertension, renal failure, and other sequelae. Low ascertainment of urinary tract infections reflects the many difficulties in establishing a diagnosis, some of which could be eliminated by a simple, reliable method for preliminary investigation of children's urine. AIM: To assess the accuracy of a new, simple method for testing urine for nitrite and leucocyte esterase, which could be applied to children in primary care. METHODS: An in vitro study was carried out to compare the results of conventional urine analysis with urine analysis on urine soaked on to panty-liners, and with the laboratory investigation. Two urine analysis stick types were used (Boehringer Mannheim Nephur sticks and Bayer Multistix 8SG) and two brands of panty-liners. Analysis examined evidence of agreement and bias for different methods in addition to sensitivity, specificity, and negative predictive values for urine analysis. RESULTS: Pressing urine analysis test sticks on to panty-liners soaked with urine achieved consistent results compared with the results of conventional dipstick urine analysis. At a prevalence of 21.8%, sensitivity and negative predictive values of urine analysis for laboratory confirmed urinary tract infection were 94% and 98%, respectively, for Boehringer sticks, and 76% and 93%, respectively, for Bayer sticks. At prevalences of 5% and 1% (prevalences that could be expected in primary care) Bayer sticks had negative predictive values of 98.7% and 99.7%, respectively, and Boehringer sticks had values of 99.6% and 99.9%, respectively. CONCLUSIONS: Testing urine on panty-liners is accurate compared with conventional urine analysis. It may be possible to apply this method to testing unwell children presenting in primary care to identify those who require microbiological urine culture to confirm or eliminate a diagnosis of urinary tract infection.

Adolescent↗
PubMed1987

Chronic dietary administration of tryptophan prevents the development of deoxycorticosterone acetate salt induced hypertension in rats.

Hypertension developed within 3 to 5 weeks in uninephrectomized rats administered deoxycorticosterone acetate (DOCA) at a dose of 850 micrograms X kg-1 X day-1 via Silastic tubes and given isotonic saline to drink. Chronic dietary administration of tryptophan (25 and 50 g/kg of food) to DOCA-treated rats reduced their exaggerated intake of NaCl solution and attenuated the elevation of blood pressure induced by treatment with DOCA alone. Treatment with tryptophan also protected against the reduction in urinary concentrating ability during a 24-h dehydration that is characteristic of DOCA-treated rats. Other tests assessed the responsiveness to the beta-adrenergic agonist, isoproterenol. These included measurement of drinking and heart rate following acute administration of isoproterenol. The characteristically depressed drinking and chronotropic responses of DOCA-treated rats to acute administration of isoproterenol were unaffected by tryptophan. Responsiveness to angiotensin II (AII) was also tested by assessment of dipsogenic and metabolic responses to acute administration of AII. The increased drinking and tail skin temperature responses to administration of AII, characteristic of DOCA-treated rats, were reduced in a graded fashion by treatment with graded doses of tryptophan. The specific binding of AII to its receptors in membranes form the diencephalon of the brain was increased by treatment with DOCA but was returned to control level by concomitant treatment with tryptophan. The content of serotonin in the mesencephalon of the brain was not changed significantly by treatment with tryptophan, but the content of 5-hydroxyindole acetic acid in the same region increased significantly, suggesting that turnover of serotonin was increased by chronic treatment with tryptophan. The cardiac hypertrophy characteristic of treatment with DOCA was attenuated significantly by chronic treatment with tryptophan, while the low, resting plasma renin activity of the DOCA-treated group was unchanged. These results suggest that tryptophan provides significant protection against the development of DOCA-induced hypertension, polydipsia, polyuria, and cardiac hypertrophy in rats. It also reduces the hyperresponsiveness to treatment with AII, possibly by decreasing the specific binding of AII to its receptors. It also appears to increase the turnover of serotonin in the brain. Whether either one or all of these is responsible for the antihypertensive effect of tryptophan remains for further study.

Angiotensin II↗