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Biomedical subjects

U Jodal

Publications and source records attributed to U Jodal.

At least 109 records · Page 6Linked to original sources
PubMed1987

Management of children with unobstructed urinary tract infection.

There are two major considerations when taking care of children with urinary tract infection (UTI): firstly to prevent renal damage and secondly to relieve symptoms. A distinction should always be made between these two aims, since they often concern separate populations that may need different treatment and follow-up strategies. Acute pyelonephritis is a common disorder of infancy and early childhood which is easily overlooked. In all infants and children in whom the cause of fever is not apparent and in all those failing to thrive, urine should be examined by dip slide culture and by an estimation of leucocyte content. With adequate care the immediate and long-term prognosis of acute pyelonephritis is excellent. Thus prevention of kidney damage is mainly a matter of putting existing knowledge into practice. Uncomplicated recurrent lower UTI involves a low risk of renal damage. Short courses of antibiotic treatment easily eradicate most such infections but have no effect on the mechanisms underlying the susceptibility to recurrence. Single-dose therapy should be considered in such instances. Long-term antibiotic prophylaxis is mainly indicated in children with a high risk of renal scarring. Treatment is not recommended for children with asymptomatic bacteriuria.

Child↗
PubMed1987

Rehabilitation of the dysfunctional bladder in children: method and 3-year followup.

A rehabilitation program has been developed for children with functional, nonneurogenic bladder disturbance. The basis for the program is a bladder regimen supplemented by biofeedback training if needed. Results in the first 70 children (64 girls and 6 boys) are presented. After 1 and 3 years 36 and 53 children, respectively, had completely normalized voiding patterns, that is they were continent, had no urgency, voided 3 to 6 times a day and emptied the bladder completely in 1 portion with a normal flow rate. The training program is applicable in children with varying urodynamic diagnoses and it has been used in children as young as 4 years old.

Adolescent↗
PubMed1987

Serum antibody response to capsular polysaccharide, outer membrane, and lipooligosaccharide in children with invasive Haemophilus influenzae type b infections.

Serum antibodies against capsular polysaccharide (CPS), outer membrane (OM), and lipooligosaccharide (LOS) from Haemophilus influenzae type b were measured by enzyme-linked immunosorbent assay in acute- and convalescent-phase sera from 21 children between 3 months and 4 years of age with invasive H. influenzae type b infections. As expected, the levels of anti-CPS antibodies in the acute-phase serum samples were low or not detectable, as were the levels of antibodies against LOS. In contrast, all children had detectable antibodies against the OM in the acute-phase serum sample, indicating that they are of little or no importance for protection. An antibody response to CPS was noted in 13 of the 21 patients, mainly in the older children. An antibody response to the OM was seen in 16 patients, with no evident relation to age. The antibody response to the OM preparation, which consisted of proteins and LOS, was probably directed mainly against the OM proteins, since only six children showed a response, usually of low magnitude, of antibodies to LOS.

Antibodies, Bacterial↗
PubMed1987

Ureteral dilatation in children with febrile urinary tract infection or bacteriuria.

Little information is available on the relationship between urinary infection in children and infants, with or without vesicoureteral reflux, and dilatation of the urinary tract. The purpose of this study was to determine the effects of infection and reflux on the diameter of the ureter at excretory urography in children with acute, febrile urinary tract infections and in infants with bacteriuria found at screening. Standardized measurements of ureteral diameter were obtained for 79 children (2 months to 6 years old) with urinary tract infections and for 45 infants with bacteriuria. Patients with urinary tract obstruction or malformations were excluded. Seventy-one children with febrile urinary tract infection had ureteral visualization that allowed measurements. Ureteral diameter in this group was significantly wider than in a reference group, and 42 children (59%) had ureteral diameters that were more than 2 standard deviations above the normal mean. Ureteral diameter at excretory urography increased with increasing grades of reflux, but dilatation occurred also in the absence of reflux. Twenty-two of the 45 infants in the group with bacteriuria had sufficient ureteral visualization for measurements. The ureters in this group were wider than in the reference group, and eight infants had ureteral diameters that were more than 2 standard deviations above the normal mean. We conclude that ureteral dilatation is a common effect of acute urinary tract infection and bacteriuria in children.

Bacteriuria↗
PubMed1987

The natural history of bacteriuria in childhood.

The highest figure for first-time UTI is found in infants below one year of age. These early infections are often pyelonephritic in character, but they are easily overlooked because symptoms are unspecific, high fever and failure to thrive being the most important. It has been shown that delay in start of treatment increases the risk of the child developing pyelonephritic scarring. There is reason to believe that undetected and therefore untreated attacks of pyelonephritis may be associated with renal scarring revealed later in life. This type of renal damage is associated with development of hypertension in about 10 per cent of children and it accounts for around 20 per cent of the children entered into dialysis and transplant programs. Prevention of such long-term problems would be of great value and pyelonephritic scarring is a potentially preventable disease. The majority of infants and young children with UTI are probably managed at the primary care level. It is therefore essential that general practitioners are well informed about the epidemiology of UTI in infancy and childhood and that adequate diagnostic facilities are provided. For example, suprapubic aspiration to obtain uncontaminated urine is a technique that may well be used in an outpatient setting, and dipslide cultures are accurate and inexpensive. In addition to young age, vesicoureteric reflux and repeated attacks of pyelonephritis are risk factors associated with development of renal scarring. Therefore, diagnostic imaging to detect children with anomalies within the urinary tract are especially important in the very young. Furthermore, long-term supervision should be provided and the parents advised to consult the doctor when there is suspicion of a new infection to avoid delay in treatment. There is no reason to perform general screening for bacteriuria in healthy infants. Although bacteriuria may be found in 1 to 2 per cent, asymptomatic children have a very high rate of spontaneous clearing of the bacteriuria and they seem to constitute a low-risk group. Instead, frequent culturing of urine from febrile infants would be much more important.

Anti-Bacterial Agents↗
PubMed1986

Pad tests in children with incontinence.

Different pad tests were compared in 50 incontinent children. In a 2-hour ward test with standardized activities and fluid provocation 70% were positive. In a simple 12-hour home test with 30 children 68% were positive; when a fluid provocation period was included in the home test with 20 children the frequency increased to 80%. Pad tests are easy to perform with children in the home and are valuable as screening instruments. Further, the simultaneous registration of events gives a more complete picture of the incontinence pattern.

Adolescent↗
PubMed1985

Epidemiology of bacteriuria during the first year of life.

Bacteriuria was studied in an unselected population of 3,581 infants. Screening was performed at three time intervals during the infants' first year of life. The public Child Health Centers cooperated in the screening and bag samples were obtained from the infants with the parents help. Bacteriuria was verified by suprapubic aspiration. 94% of the infants took part in the screening and bacteriuria was confirmed in 14 girls (0.9%) and 36 boys (2.5%). An additional 20 girls (1.1%) and 20 boys (1.2%) in the study population presented with symptomatic urinary tract infection before 12 months of age. Bacteriuria in boys was predominantly found early in infancy both with screening techniques and through symptomatic urinary tract infections.

Age Factors↗
PubMed1984

Virulence-associated traits in Escherichia coli causing first and recurrent episodes of urinary tract infection in children with or without vesicoureteral reflux.

Virulence-associated properties of 606 urinary isolates from 174 children with urinary tract infections were related to severity of infection and factors increasing host susceptibility, e.g., vesicoureteral reflux (grade II or higher) and P1 blood group phenotype. A high proportion of strains of Escherichia coli causing first or recurrent episodes of acute pyelonephritis in children without reflux expressed the previously noted high frequency of certain O antigens, resistance to serum killing, hemolysin production, and adhesive capacity. A significantly lower frequency of these traits and a higher frequency of non-E. coli were seen among isolates from children with pyelonephritis and reflux, cystitis, and asymptomatic bacteriuria. Reflux was thus found to be a determinant of the level of infection and of the bacterial properties required to produce pyelonephritis. Efforts aimed at preventing or treating urinary tract infection by interfering with "virulent" bacteria may be of less value in patients with recurrent pyelonephritis and reflux, who are most likely to develop renal scars.

Adhesiveness↗
PubMed1984

Escherichia coli K5 antigen in relation to various infections and in healthy individuals.

A phage specific for Escherichia coli K5 antigen was used to determine the frequency of K5 in strains of E. coli isolated from cases of sepsis, meningitis, and urinary tract infection (pyelonephritis, cystitis, and asymptomatic bacteriuria), as well as from fecal samples of healthy subjects. Although entirely absent from meningitic strains, K5 was found to be one of the most common E. coli capsular antigens, especially in strains causing sepsis. K5 was less common in the fecal strains of healthy subjects than in strains causing various urinary tract infections, between which there was no significant difference in its frequency. Thus, even if K5 is a less important antigen than K1 in the etiology of acute pyelonephritis or acute meningitis, as the fifth most commonly occurring K antigen in E. coli strains causing urinary tract infection it should be included as a component in any K antigen-based vaccine against acute pyelonephritis.

Antigens↗
PubMed1984

Angiotensin converting enzyme inhibitor treatment of hypertension in infancy and childhood.

Captopril treatment was given to 30 children aged 8 months to 16 years (mean age 10.1 years) with renal hypertension when combinations of one or more of betablockers, diuretics, clonidine and hydralazine had failed to reduce blood pressure in the majority of the children. Dosages of captopril varied between 0.5 and 11.0 mg/kg BW, which was combined with furosemide in 15 cases, betablockers in three cases, betablockers and clonidine in two cases. Pretreatment mean plasma renin activity (PRA) was 7.9 (0.8-89.4) ng AT/ml/h in 22 of the 30 children and 59% had more than 2.0 ng AT/ml/h. Blood pressure fell from a mean of 158/109 (range 135/75 - 240/140) mm Hg to a mean of 120/76 (range 110/65 - 150/100) mm Hg. Mean duration time was 10.1 months (1-47 months). Skin rash occurred in three cases and taste disturbance in one case. Falling glomerular filtration rate was observed in two children with diseases of the renal vessels. After withdrawal of captopril renal function returned to the pretreatment level. Angiotensin converting enzyme inhibition for treatment of hypertension in childhood has proved to be efficient and safe in these 30 children.

Adolescent↗
PubMed1984

Growth during treatment with low-protein diet in children with renal failure.

Fourteen children, 10 boys and 4 girls, with chronic progressive renal failure were treated with a low-protein (0.4-2 g/kg body wt and maximum 20 g/day), high-energy diet (55-130 kcal/kg body wt) and supplemented with essential amino acids and histidine (0.21-0.5 g/kg body wt). The mean age at the onset of treatment was 9.9 years (5.5 months - 15.3 years), mean serum creatinine 461 mumoles/1 (167-1110) and mean BUN 60.2 mmoles/1 (20-83). Indications for treatment were incipient or manifest growth retardation. A 50% reduction of BUN was found after about 2 weeks of treatment while serum creatinine remained unchanged. BUN remained decreased during therapy despite further increase of serum creatinine. The mean duration of treatment was 21 months (range 4-48). Increasing appetite and vitality were found after introduction of the diet, which was well accepted by most of the children while their general condition remained satisfactory. The earlier decrease of growth rate was interrupted and a linear or almost linear growth within the SD-scores at onset of treatment was seen in 10 of the 14 children. Three children had a reduced growth rate and one child did not grow at all during treatment. Signs of osteodystrophy did not improve during the diet. It is speculated that the protein restriction has a detoxifying effect, which together with supplementation of amino acids and a high energy supply could in part correct the metabolic disturbances and provide an opportunity for anabolism and growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Correlation of P blood group, vesicoureteral reflux, and bacterial attachment in patients with recurrent pyelonephritis.

Bacterial attachment to urinary-tract epithelium is important in the pathogenesis of urinary-tract infection. Most pyelonephritogenic Escherichia coli bind specifically to epithelial-cell receptors, which are glycolipids of the globoseries and also antigens in the P blood-group system. Among 36 girls with recurrent pyelonephritis who did not have vesicoureteral reflux, we found that attaching bacteria were common and the P1 blood-group phenotype was present in 97 per cent, as compared with 75 per cent of 84 age-matched children without urinary-tract infection (P less than 0.01). In 32 girls with recurrent pyelonephritis who had reflux, attaching bacteria were rare, and the frequency of the P1 phenotype was not significantly higher than in controls (82 per cent, P greater than 0.05). In the group of patients with the P1 phenotype, 68 per cent of the urinary bacterial isolates from those without reflux, but only 25 per cent of isolates from those with reflux, bound to globotetraosylceramide, as determined by a receptor-coating technique (P less than 0.001). Our data suggest that, in the absence of reflux, the P1 blood group contributes to susceptibility to recurrent pyelonephritis due to bacteria that bind to the glycolipid receptors of the globoseries. In the presence of reflux, uroepithelial attachment does not seem to confer an advantage to bacteria that infect the kidney.

Adhesiveness↗