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von Gontard A, Kuwertz-Bröking E. [Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 51:375-400. [PMID: 37272401 DOI: 10.1024/1422-4917/a000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Abstract: Objective: Enuresis and daytime urinary incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. This interdisciplinary guideline summarizes the current state of knowledge regarding somatic and psychiatric assessment and treatment. We formulate consensus-based, practical recommendations. Methods: The members of this guideline commission consisted of 18 professional associations. The guideline results from current literature searches, several online surveys, and consensus conferences based on standard procedures. Results: According to the International Children's Continence Society (ICCS), there are four different subtypes of nocturnal enuresis and nine subtypes of daytime urinary incontinence. Organic factors first have to be excluded. Clinical and noninvasive assessment is sufficient in most cases. Standard urotherapy is the mainstay of treatment. If indicated, one can add specific urotherapy and pharmacotherapy. Medication can be useful, especially in enuresis and urge incontinence. Psychological and somatic comorbid disorders must also be addressed. Conclusions: The recommendations of this guideline were passed with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required especially regarding functional (nonorganic) daytime urinary incontinence.
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Affiliation(s)
- Alexander von Gontard
- Psychiatrische Dienste Graubünden, Ambulante Dienste für Kinder- und Jugendpsychiatrie, Chur, Schweiz
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, Niederlande
| | - Eberhard Kuwertz-Bröking
- Ehemals: Universitätsklinikum Münster, Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Nephrologie, Münster, Deutschland
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Han JX, Tao ZH, Wang JL, Zhang L, Yu CY, Kang ZR, Xie Y, Li J, Lu S, Cui Y, Xu J, Zhao E, Wang M, Chen J, Wang Z, Liu Q, Chen HM, Su W, Zou TH, Zhou CB, Hong J, Chen H, Xiong H, Chen YX, Fang JY. Microbiota-derived tryptophan catabolites mediate the chemopreventive effects of statins on colorectal cancer. Nat Microbiol 2023; 8:919-933. [PMID: 37069401 DOI: 10.1038/s41564-023-01363-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 03/16/2023] [Indexed: 04/19/2023]
Abstract
Epidemiological studies have indicated an association between statin use and reduced incidence of colorectal cancer (CRC), and work in preclinical models has demonstrated a potential chemopreventive effect. Statins are also associated with reduced dysbiosis in the gut microbiome, yet the role of the gut microbiome in the protective effect of statins in CRC is unclear. Here we validated the chemopreventive role of statins by retrospectively analysing a cohort of patients who underwent colonoscopies. This was confirmed in preclinical models and patient cohorts, and we found that reduced tumour burden was partly due to statin modulation of the gut microbiota. Specifically, the gut commensal Lactobacillus reuteri was increased as a result of increased microbial tryptophan availability in the gut after atorvastatin treatment. Our in vivo studies further revealed that L. reuteri administration suppressed colorectal tumorigenesis via the tryptophan catabolite, indole-3-lactic acid (ILA). ILA exerted anti-tumorigenic effects by downregulating the IL-17 signalling pathway. This microbial metabolite inhibited T helper 17 cell differentiation by targeting the nuclear receptor, RAR-related orphan receptor γt (RORγt). Together, our study provides insights into an anti-cancer mechanism driven by statin use and suggests that interventions with L. reuteri or ILA could complement chemoprevention strategies for CRC.
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Affiliation(s)
- Ji-Xuan Han
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Hang Tao
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ji-Lin Wang
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Zhang
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen-Yang Yu
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zi-Ran Kang
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanhong Xie
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jialu Li
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shiyuan Lu
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Cui
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Xu
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Enhao Zhao
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Wang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinxian Chen
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Wang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Liu
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui-Min Chen
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenyu Su
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tian-Hui Zou
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng-Bei Zhou
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Hong
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haoyan Chen
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Xiong
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Ying-Xuan Chen
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Jing-Yuan Fang
- Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Martenstyn JA, Machaalani R, Caldwell P, Waters KA. Relationship between sleep respiration, architecture and childhood enuresis: Correlates between polysomnography and questionnaire. J Paediatr Child Health 2021; 57:1923-1928. [PMID: 34152048 DOI: 10.1111/jpc.15613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/05/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
AIM Nocturnal enuresis (NE) and sleep-disordered breathing (SDB) are common in childhood. While the two disorders are linked, those links are still being clarified. METHODS This study compared sleep profiles and enuresis-related behaviours between children with NE and those without, who were referred to a tertiary sleep unit with suspected SDB, using the combination of polysomnography (PSG) and questionnaire. Continuous numerical data were analysed after adjusting for body mass index z-score. RESULTS The study included 52 Children (39 boys, 13 girls) aged 5-14 years. Twenty-one had enuresis (10 monosymptomatic enuresis (MNE) and 11 non-monosymptomatic enuresis (NMNE)) and 31 did not have enuresis. The majority had comorbidities. On PSG, all children with NE had moderate obstructive sleep apnoea (OSA) compared to the control group which were of mild OSA. Children with NMNE had a higher percentage time in stage-3 non-REM sleep when compared to the non-enuretic and MNE groups (P < 0.05). On the questionnaire, more parents of the NE groups reported that their child was 'difficult to wake in the morning' (P < 0.05). CONCLUSION In this heterogeneous population referred for suspected SDB, children with NE had moderate OSA, yet those with MNE had increased arousals and more often report difficulty waking than children with suspected SDB who do not wet, while children with NMNE exhibit changes in sleep architecture suggesting deeper sleep. These differences may impact treatment choices for children with enuresis.
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Affiliation(s)
- Jordan A Martenstyn
- Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia.,Sleep Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rita Machaalani
- Sleep Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrina Caldwell
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Karen A Waters
- Sleep Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Lack of Efficacy of Lactobacillus reuteri DSM 17938 for the Treatment of Acute Gastroenteritis: A Randomized Controlled Trial. Pediatr Infect Dis J 2019; 38:e237-e242. [PMID: 31033909 DOI: 10.1097/inf.0000000000002355] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the efficacy of Lactobacillus reuteri DSM 17938 (L. reuteri) for the treatment of acute gastroenteritis in children. STUDY DESIGN Children younger than 5 years with acute diarrhea, defined as a change in stool consistency to a loose or liquid form and/or an increase in the frequency of evacuations (≥3 in 24 hours), lasting for no longer than 5 days, were eligible for inclusion. Participants (n = 100) were recruited from the pediatrics department of a Polish hospital and randomly assigned to receive L. reuteri in a dose 2 × 10 colony-forming units or placebo, for 5 days, in addition to standard rehydration therapy. The primary outcome measure was duration of diarrhea. RESULTS Ninety-one of the 100 children randomized were included in the intention-to-treat analysis (L. reuteri n = 44; placebo n = 47). The duration of diarrhea after randomization in both groups was similar (P = 0.6). The groups were also similar with respect to all secondary outcome measures, with one exception. Compared with the placebo group, patients in the L. reuteri group had a shorter duration of hospitalization (P = 0.048). Adverse events were similar in both groups. CONCLUSIONS Among children with acute gastroenteritis who were younger than 5 years of age, L. reuteri compared with placebo, as an adjunct to rehydration therapy, did not reduce the duration of diarrhea; however, it reduced the duration of hospitalization.
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Kim YJ, Park KH, Park DA, Park J, Bang BW, Lee SS, Lee EJ, Lee HJ, Hong SK, Kim YR. Guideline for the Antibiotic Use in Acute Gastroenteritis. Infect Chemother 2019; 51:217-243. [PMID: 31271003 PMCID: PMC6609748 DOI: 10.3947/ic.2019.51.2.217] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Indexed: 12/23/2022] Open
Abstract
Acute gastroenteritis is common infectious disease in community in adults. This work represents an update of 'Clinical guideline for the diagnosis and treatment of gastrointestinal infections' that was developed domestically in 2010. The recommendation of this guideline was developed regarding the following; epidemiological factors, test for diagnosis, the indications of empirical antibiotics, and modification of antibiotics after confirming pathogen. Ultimately, it is expected to decrease antibiotic misuse and prevent antibiotic resistance.
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Affiliation(s)
- Youn Jeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Ho Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Joonhong Park
- Department of Laboratory Medicine, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Byoung Wook Bang
- Division of Gastroenterology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seung Soon Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Eun Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyo Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sung Kwan Hong
- Division of Infectious Diseases, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yang Ree Kim
- Division of Infectious Diseases, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
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Ahmadipour S, Mohsenzadeh A, Alimadadi H, Salehnia M, Fallahi A. Treating Viral Diarrhea in Children by Probiotic and Zinc Supplements. Pediatr Gastroenterol Hepatol Nutr 2019; 22:162-170. [PMID: 30899692 PMCID: PMC6416388 DOI: 10.5223/pghn.2019.22.2.162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of this study was to analyze the effects of probiotics and zinc supplements on the mean duration and frequency of acute diarrhea in children aged 6 months to 2 years. METHODS In this clinical trial of infants aged between 6 months and 2 years, eligible patients were divided into 3 groups: Zinc Receiving Group (ZRG), Probiotic Receiving Group (PRG), and a control group receiving supportive care alone. The frequency of diarrhea was evaluated in the test groups during the first 24 hours and 48-72 hours, along with the duration of hospitalization and diarrhea persistence for 3-7 days. RESULTS Diarrhea persisted for until the third day of admission in 100% of the infants in PRG compared with only 76.1% in ZRG. The relative risk of diarrhea persistence in the PRG was 1.31 times more than in ZRG until the third day. Also, 80% of diarrhea cases in the PRG persisted until the fourth day of admission, compared with 47.8% in the ZRG group, and this value was significant. The relative incidence of diarrhea persistence in the PRG was 36.4 times greater than in the ZRG until the day 4. Also, the percentage of post-treatment complications was 35.5% in the PRG and 2.6% in the ZRG, which was significant. CONCLUSION In our study, the effectiveness of zinc at a dose of 20 mg was higher than that of probiotics. The complications associated with zinc supplementation were lower than those of probiotics.
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Affiliation(s)
- Shokoufeh Ahmadipour
- Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran
- Pediatric Gastroenterology and Hepatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Mohsenzadeh
- Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hosein Alimadadi
- Pediatric Gastroenterology and Hepatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Salehnia
- Children's Medical Center, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Arash Fallahi
- Pediatric Gastroenterology and Hepatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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do Carmo MS, Santos CID, Araújo MC, Girón JA, Fernandes ES, Monteiro-Neto V. Probiotics, mechanisms of action, and clinical perspectives for diarrhea management in children. Food Funct 2019; 9:5074-5095. [PMID: 30183037 DOI: 10.1039/c8fo00376a] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infectious diarrhea is the second most common cause of morbidity and mortality in children under 5 years of age in the underdeveloped areas of the world. Conventional treatment consists of rehydration, which may be coupled with antimicrobial agents in more severe bacterial infections or with antiprotozoal agents. In the last few decades, research on the use of probiotic strains, such as Lactobacillus rhamnosus GG ATCC 53013 (LGG), Lactobacillus reuteri DSM 17938 and Saccharomyces boulardii, has gained much attention to prevent and treat diarrheal diseases. However, they are rarely used in the clinical routine, perhaps because there are still gaps in the knowledge about the effective benefit to the patient in terms of the reduction of the duration of diarrhea and its prevention. Furthermore, only a few probiotic strains are safely indicated for usage in pediatric practice. This review summarizes the current knowledge on the antimicrobial mechanisms of probiotics on distinct enteropathogens and their role in stimulating host defense mechanisms against intestinal infections. In addition, we highlight the potential of probiotics for the treatment and prevention of diarrhea in children. We conclude that the use of probiotics is beneficial for both the treatment and prevention of diarrhea in children and that the identification of other candidate probiotics might represent an important advance to a greater reduction in hospital stays and to prevent infectious diarrhea in a larger portion of this population.
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Affiliation(s)
- Monique Santos do Carmo
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brazil
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Pavlinac PB, Brander RL, Atlas HE, John-Stewart GC, Denno DM, Walson JL. Interventions to reduce post-acute consequences of diarrheal disease in children: a systematic review. BMC Public Health 2018; 18:208. [PMID: 29391004 PMCID: PMC5796301 DOI: 10.1186/s12889-018-5092-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/17/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although acute diarrhea often leads to acute dehydration and electrolyte imbalance, children with diarrhea also suffer long term morbidity, including recurrent or prolonged diarrhea, loss of weight, and linear growth faltering. They are also at increased risk of post-acute mortality. The objective of this systematic review was to identify interventions that address these longer term consequences of diarrhea. METHODS We searched Medline for randomized controlled trials (RCTs) of interventions conducted in low- and middle-income countries, published between 1980 and 2016 that included children under 15 years of age with diarrhea and follow-up of at least 7 days. Effect measures were summarized by intervention. PRISMA guidelines were followed. RESULTS Among 314 otherwise eligible RCTs, 65% were excluded because follow-up did not extend beyond 7 days. Forty-six trials were included, the majority of which (59%) were conducted in Southeast Asia (41% in Bangladesh alone). Most studies were small, 76% included less than 200 participants. Interventions included: therapeutic zinc alone (28.3%) or in combination with vitamin A (4.3%), high protein diets (19.6%), probiotics (10.9%), lactose free diets (10.9%), oral rehydration solution (ORS) formulations (8.7%), dietary supplements (6.5%), other dietary interventions (6.5%), and antimicrobials (4.3%). Prolonged or recurrent diarrhea was the most commonly reported outcome, and was assessed in ORS, probiotic, vitamin A, and zinc trials with no consistent benefit observed. Seven trials evaluated mortality, with follow-up times ranging from 8 days to 2 years. Only a single trial found a mortality benefit (therapeutic zinc). There were mixed results for dietary interventions affecting growth and diarrhea outcomes in the post-acute period. CONCLUSION Despite the significant post-acute mortality and morbidity associated with diarrheal episodes, there is sparse evidence evaluating the effects of interventions to decrease these sequelae. Adequately powered trials with extended follow-up are needed to identify effective interventions to prevent post-acute diarrhea outcomes.
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Affiliation(s)
| | | | - Hannah E. Atlas
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Grace C. John-Stewart
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
- Department of Pediatrics, University of Washington, Seattle, WA USA
- Department of Medicine (Infectious Disease), University of Washington, Seattle, WA USA
| | - Donna M. Denno
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Pediatrics, University of Washington, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
- Department of Pediatrics, University of Washington, Seattle, WA USA
- Department of Medicine (Infectious Disease), University of Washington, Seattle, WA USA
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Jönson Ring I, Markström A, Bazargani F, Nevéus T. Sleep disordered breathing in enuretic children and controls. J Pediatr Urol 2017; 13:620.e1-620.e6. [PMID: 28673796 DOI: 10.1016/j.jpurol.2017.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/20/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nocturnal enuresis and sleep disordered breathing are common childhood problems that are reported to be associated with each other. Sleep disordered breathing is often found in children with upper airway obstruction and, according to some studies, its presence is associated with an increased risk of nocturnal enuresis. Respiration during sleep in children with therapy-resistant enuresis, but no history of snoring or sleep apneas, has previously been investigated, and subclinical signs of disordered respiration were found in this group. However, sleep disordered breathing in enuretic children without a history of snoring or sleep apneas has not been thoroughly studied before. AIM To evaluate sleep disordered breathing in enuretic children and compare them with healthy control children. SUBJECTS AND METHODS Children aged 8-13 years with nocturnal enuresis were included. Exclusion criteria were: daytime incontinence, on-going anti-enuretic treatment, and concomitant urological, endocrinological, nephrological or psychiatric disorders. Twenty children (19 boys and 1 girl) suffering from therapy-resistant nocturnal enuresis, and 21 healthy controls (18 boys and 3 girls) underwent one night of polygraphic sleep registration focused on respiratory variables. The registration included electroencephalography as well as assessment of respiratory movements, nasal airflow and oxygen saturation; it was performed with a portable sleep device at the subjects' homes. In addition to this, OSA 18, a health-related quality of life instrument, was used to evaluate subjective issues related to sleep and breathing. RESULTS The mean apnea hypopnea index values were 0.96 ± 0.8 for the patient group and 0.46 ± 0.4 for the control group. The oxygen desaturation index was slightly higher for the children with nocturnal enuresis compared with the healthy controls (P = 0.05). No other differences were found in the respiratory variables. Both groups of children showed low levels of arousals (Summary Table). The enuretic children reported significantly more subjective sleep disturbances and a lower quality of life than their healthy peers. DISCUSSION This was the first controlled study of sleep disordered breathing in children with nocturnal enuresis. One limitation of the study was that some variables were known to be underestimated when scoring polygraphic data. The apnea hypopnea index was such a variable and was indeed lower than in a previous study. CONCLUSION No major differences in respiration during sleep were found between enuretic children and controls.
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Affiliation(s)
- Ingrid Jönson Ring
- Department of Orthodontics, Public Dental Service, Uppsala, Region Uppsala County, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
| | - Agneta Markström
- Department of Medical Sciences, Lung, Allergy and Sleep Research, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Farhan Bazargani
- Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Region Örebro County, Sweden
| | - Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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Soster LA, Alves RC, Fagundes SN, Lebl A, Garzon E, Koch VH, Ferri R, Bruni O. Non-REM Sleep Instability in Children With Primary Monosymptomatic Sleep Enuresis. J Clin Sleep Med 2017; 13:1163-1170. [PMID: 28859716 PMCID: PMC5612631 DOI: 10.5664/jcsm.6762] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES Sleep enuresis is one of the most common sleep disturbances in childhood. Parental perception of deeper sleep in children with sleep enuresis is not confirmed by objective studies. However, evidence of disturbed sleep has been demonstrated by questionnaire, actigraphy, and polysomnographic studies, but no neurophysiological correlation with low arousability has been found. The goal of this study was to analyze the sleep microstructure of children with sleep enuresis using cyclic alternating pattern (CAP) analysis. METHODS Forty-nine children were recruited, 27 with enuresis (19 males and 8 females, mean age 9.78 years, 2.52 standard deviation) and 22 normal control patients (11 males and 11 females, mean age 10.7 years, 3.43 standard deviation); all subjects underwent clinical evaluation followed by a full-night polysomnographic recording. Psychiatric, neurological, respiratory, and renal diseases were excluded. RESULTS No differences in sex, age, and apnea-hypopnea index were noted in the patients with enuresis and the control patients. Sleep stage architecture in children with sleep enuresis showed a decrease in percentage of stage N3 sleep. CAP analysis showed an increase in CAP rate in stage N3 sleep and in phase A1 index during stage N3 sleep in the sleep enuresis group, but also a significant reduction of A2% and A3% and of phases A2 and A3 indexes, supporting the concept of decreased arousability in patients with sleep enuresis. The decrease of phase A2 and A3 indexes in our patients might reflect the impaired arousal threshold of children with sleep enuresis. Sleep fragmentation might result in a compensatory increase of slow wave activity (indicated by the increase of CAP rate in stage N3 sleep) and may explain the higher arousal threshold (indicated by a decrease of phase A2 and A3 indexes) linked to an increased sleep pressure. CONCLUSIONS The findings of this study indicate the presence of a significant disruption of sleep microstructure (CAP) in children with sleep enuresis, supporting the hypothesis of a higher arousal threshold.
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Affiliation(s)
- Leticia Azevedo Soster
- Neurology Division, Hospital das Clínicas, São Paulo University (HC/FMUSP), São Paulo, Brazil
| | - Rosana Cardoso Alves
- Neurology Division, Hospital das Clínicas, São Paulo University (HC/FMUSP), São Paulo, Brazil
| | | | - Adrienne Lebl
- Pediatric Division, Hospital das Clínicas, São Paulo University (HC/FMUSP), São Paulo, Brazil
| | - Eliana Garzon
- Neurology Division, Hospital das Clínicas, São Paulo University (HC/FMUSP), São Paulo, Brazil
| | - Vera H. Koch
- Pediatric Division, Hospital das Clínicas, São Paulo University (HC/FMUSP), São Paulo, Brazil
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Oliviero Bruni
- Center for Pediatric Sleep Disorders, Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
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Basiri A, Bahrainian SA, Khoshdel A, Jalaly N, Golshan S, Pakmanesh H. Primary nocturnal enuresis is associated with lower intelligence quotient scores in boys from poorer socioeconomic status families. Int J Urol 2017; 24:217-221. [PMID: 28122391 DOI: 10.1111/iju.13282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/30/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To explore intelligence quotient in boys with primary nocturnal enuresis compared with normal boys considering their socioeconomic status. METHODS A total of 152 school-aged boys (including 55 boys with primary nocturnal enuresis and 97 matched normal controls) were assessed. Boys with a history of any neurological or urological disease were excluded. Two different districts of Tehran: Khani-Abad (a poor district) and Pirouzi (a middle class district) districts were enrolled according to socioeconomic status data reported by the World Health Organization. Intelligence tests were carried out using a validated Iranian translation of the Wechsler Intelligence Scale for Children Revised. Total, as well as performance intelligence quotient and verbal intelligence quotient scores and verbal-performance discrepancy (the difference between verbal and performance intelligence quotient scores for each individual) were compared using a t-test between boys with primary nocturnal enuresis in each district and their matched controls. RESULTS Considering each district separately, the total intelligence quotient score was lower in primary nocturnal enuresis cases than controls only in the lower income district (90.7 ± 23.3 vs 104.8 ± 14.7, P = 0.002). Similarly, boys with primary nocturnal enuresis ranked lower in verbal intelligence quotient (P = 0.002) and performance intelligence quotient (P = 0.004) compared with their matched normal controls only in lower income district, whereas in the higher income district, boys with primary nocturnal enuresis ranked similar in total intelligence quotient to their matched controls. CONCLUSIONS Boys with primary nocturnal enuresis had a lower intelligence quotient compared with the control participants only in low-income district. It seems important to adjust the results of the intelligence quotient assessment in these children according to their socioeconomic status.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Alireza Khoshdel
- School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Niloofar Jalaly
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Golshan
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Pakmanesh
- Urology Department, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
- Urology and Nephrology Research Center (UNRC), Tehran, Iran
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12
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Kim SC. Management of patients with refractory nocturnal enuresis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.10.800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seong Cheol Kim
- Department of Urology, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea
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13
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Impact of a multidisciplinary evaluation in pediatric patients with nocturnal monosymptomatic enuresis. Pediatr Nephrol 2016; 31:1295-303. [PMID: 26913724 DOI: 10.1007/s00467-016-3316-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/19/2015] [Accepted: 12/20/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Enuresis (NE) is a clinical condition of multifactorial etiology that leads to difficulties in child/adolescent social interaction. METHODS This was a prospective study on the impact of multidisciplinary assessment of 6- to 17-year-old patients with monosymptomatic nocturnal enuresis (MNE), including a structured history, clinical/neurological examination, bladder and bowel diaries, sleep diary and questionnaires, psychological evaluation [Child Behavior Checklist (CBCL) and PedsQL 4.0 questionnaires], urinary sonography, blood and urine laboratory tests, polysonography (PSG), and balance evaluation. RESULTS A total of 140 enuretic participants were evaluated, of whom 27 were diagnosed with NE complicated by urinary disorder, four with hypercalciuria, three with nephropathy and one with attention-deficit hyperactivity disorder. Among the 87 participants who underwent PSG, six were diagnosed with severe apnea. Of the 82 MNE patients who underwent full assessment, 62 were male (75.6 %), and the mean age was 9.5 (±2.6) years. A family history of NE was diagnosed in 91.1 % of first- and second-degree relatives, constipation in 89.3 % and mild/moderate apnea in 40.7 %. Balance control alteration was identified by physical therapy evaluation of MNE patients. Participants' quality of life evaluation scores were significantly lower than those of their parents. CONCLUSION Enuresis is a multifactorial disorder that requires a structured diagnostic approach.
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Ang LYE, Too HKI, Tan EL, Chow TKV, Shek LPC, Tham EH, Alonso S. Antiviral activity of Lactobacillus reuteri Protectis against Coxsackievirus A and Enterovirus 71 infection in human skeletal muscle and colon cell lines. Virol J 2016; 13:111. [PMID: 27341804 PMCID: PMC4920999 DOI: 10.1186/s12985-016-0567-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/20/2016] [Indexed: 12/31/2022] Open
Abstract
Background Recurrence of hand, foot and mouth disease (HFMD) pandemics continues to threaten public health. Despite increasing awareness and efforts, effective vaccine and drug treatment have yet to be available. Probiotics have gained recognition in the field of healthcare worldwide, and have been extensively prescribed to babies and young children to relieve gastrointestinal (GI) disturbances and diseases, associated or not with microbial infections. Since the faecal-oral axis represents the major route of HFMD transmission, transient persistence of probiotic bacteria in the GI tract may confer some protection against HFMD and limit transmission among children. Methods In this work, the antiviral activity of two commercially available probiotics, namely Lactobacillus reuteri Protectis (L. reuteri Protectis) and Lactobacillus casei Shirota (L. casei Shirota), was assayed against Coxsackieviruses and Enterovirus 71 (EV71), the main agents responsible for HFMD. In vitro infection set-ups using human skeletal muscle and colon cell lines were designed to assess the antiviral effect of the probiotic bacteria during entry and post-entry steps of the infection cycle. Results Our findings indicate that L. reuteri Protectis displays a significant dose-dependent antiviral activity against Coxsackievirus type A (CA) strain 6 (CA6), CA16 and EV71, but not against Coxsackievirus type B strain 2. Our data support that the antiviral effect is likely achieved through direct physical interaction between bacteria and virus particles, which impairs virus entry into its mammalian host cell. In contrast, no significant antiviral effect was observed with L. casei Shirota. Conclusions Should the antiviral activity of L. reuteri Protectis observed in vitro be translated in vivo, such probiotics-based therapeutic approach may have the potential to address the urgent need for a safe and effective means to protect against HFMD and limit its transmission among children.
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Affiliation(s)
- Lei Yin Emily Ang
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, #03-05, Singapore, 117456, Singapore.,Immunology programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Horng Khit Issac Too
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, #03-05, Singapore, 117456, Singapore.,Immunology programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Eng Lee Tan
- Department of Paediatrics, National University Hospital, Singapore, Singapore.,Centre for Biomedical & Life Sciences, Singapore Polytechnic, Singapore, Singapore
| | - Tak-Kwong Vincent Chow
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, #03-05, Singapore, 117456, Singapore
| | | | | | - Sylvie Alonso
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, #03-05, Singapore, 117456, Singapore. .,Immunology programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore.
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15
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Sleep disturbances associated with sleep enuresis: A questionnaire study. Eur J Paediatr Neurol 2016; 20:282-285. [PMID: 26732069 DOI: 10.1016/j.ejpn.2015.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/28/2015] [Accepted: 11/29/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Sleep enuresis (SE) is the second most common sleep complaint in childhood. It has been associated with bladder hyperactivity, excessive urine production and deeper sleep. Several sleep disorders have been described in association with SE like parasomnias and sleep apnea. The aim of this study was to analyze the presence of sleep disturbances in children with SE through the use of Sleep Disturbance Scale for Children (SDSC) compared to normal children matched for age and sex. METHODS A questionnaire evaluation was performed in 76 enuretic and 112 normal children through the Sleep Disturbance Scale for Children (SDSC) validated for Portuguese language. The Scale is grouped into six subscales: Disorders in Initiating and Maintaining Sleep (DIMS), Sleep Breathing Disorders (SBD), Disorders of Arousal (DA), Sleep-Wake Transition Disorders (SWTD), Disorders Of Excessive Somnolence (DOES), and Nocturnal Hyperhidrosis (SHY). Children with renal and neurological problems were excluded from both groups. RESULTS Enuretics scored higher in several of the subscales (SBD, DOA, SWTD) and also in the total scale scores while scored low in the DIMS subscale. No differences were found for the DOES and SHY subscales. CONCLUSIONS Enuretic children showed a high comorbidity with other sleep disturbances like sleep disordered breathing and parasomnias. The novel finding of this study is that we found a decreased incidence of DIMS that is consistent with the parental perception of a more deep sleep and a high arousal threshold in SE.
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16
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Dahan P, de Bessa J, de Oliveira DM, Gomes CC, Cardoso JC, Macedo IT, de Almeida Belo M, de Figueiredo AA, Netto JMB. Association between Asthma and Primary Nocturnal Enuresis in Children. J Urol 2016; 195:1221-6. [PMID: 26926555 DOI: 10.1016/j.juro.2015.10.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Enuresis, sleep respiratory disorders and asthma compromise the quality of sleep in children and may occur in association with each other. An association between sleep respiratory disorders and enuresis has already been demonstrated. According to united airways disease abnormalities of the upper and lower airways may coexist. A child who wheezes has a greater chance of snoring and having obstructive sleep apnea. Since asthma and sleep respiratory disorders may be associated, and sleep respiratory disorders are associated with enuresis, we determined the possibility of an association between asthma and enuresis. MATERIALS AND METHODS Between August 20 and March 2015 parents/guardians of children 6 to 14 years old from 16 elementary schools in our area were randomly chosen for study. Children with nonmonosymptomatic enuresis and urological or neurological disease were excluded. The Tucson and ISAAC (International Study of Asthma and Allergies in Childhood) questionnaires were used to assess sleep respiratory disorders and asthma, respectively. RESULTS A total of 523 children (283 males and 240 females) with a mean ± SD age of 9.42 ± 2.46 years were included in analysis. The overall prevalence of enuresis was 15.87% (95% CI 12.98-19.26). Asthmatic children with wheezing in the last 12 months were 2.33 times more likely to have had enuresis at some point in life (OR 2.33, 95% CI 1.37-3.95, p = 0.0017). If enuresis was present, the chance increased to 2.78 (95% CI 1.38-5.61, p = 0.0041). Enuretic children were 5.34 times more prone to have apnea reported by parents (95% CI 2.19-13.03, p = 0.0002). CONCLUSIONS These findings demonstrate that asthma as well as sleep respiratory disorders is associated with primary nocturnal enuresis.
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Affiliation(s)
- Patricia Dahan
- Department of Pediatrics, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil; Department of Pediatrics, School of Medicine of University Presidente Antônio Carlos, Barbacena, Brazil.
| | - José de Bessa
- Division of Urology, Department of Surgery, State University of Feira de Santana, Feira de Santana, Brazil
| | - Dayana Maria de Oliveira
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Camila Couto Gomes
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Julio Cesar Cardoso
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Isabela Teixeira Macedo
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Mariana de Almeida Belo
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | | | - José Murillo B Netto
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil; Division of Urology, Department of Surgery, Hospital e Maternidade Therezinha de Jesus, School of Medical Science and Health of Juiz de Fora, Juiz de Fora, Brazil
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17
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Caffarelli C, Cardinale F, Povesi-Dascola C, Dodi I, Mastrorilli V, Ricci G. Use of probiotics in pediatric infectious diseases. Expert Rev Anti Infect Ther 2015; 13:1517-35. [PMID: 26496433 DOI: 10.1586/14787210.2015.1096775] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We summarize current evidence and recommendations for the use of probiotics in childhood infectious diseases. Probiotics may be of benefit in treating acute infectious diarrhea and reducing antibiotic-associated diarrhea. Potential benefits of probiotic on prevention of traveler's diarrhea,Clostridium difficile-associated diarrhea, side effects of triple therapy in Helicobacter pylori eradication, necrotizing enterocolitis, acute diarrhea, acute respiratory infections and recurrent urinary tract infections remain unclear. More studies are needed to investigate optimal strain, dosage, bioavailability of drops and tablets, duration of treatment and safety. Probiotics and recombinant probiotic strain represent a promising source of molecules for the development of novel anti-infectious therapy.
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Affiliation(s)
- Carlo Caffarelli
- a Clinica Pediatrica, Dipartimento di Medicina Clinica e Sperimentale , Azienda Ospedaliero Universitaria di Parma, Università di Parma , Parma , Italy
| | - Fabio Cardinale
- b Azienda Ospedaliero-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII , Bari , Italy
| | - Carlotta Povesi-Dascola
- c Clinica Pediatrica , Azienda Ospedaliero Universitaria di Parma, Università di Parma , Parma , Italy
| | - Icilio Dodi
- d Dipartimento Cure Primarie, Pediatria Di Comunita` , Azienda Unità Sanitaria Locale di Parma , Parma , Italy
| | - Violetta Mastrorilli
- b Azienda Ospedaliero-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII , Bari , Italy
| | - Giampaolo Ricci
- e Gozzadini" Children's Hospital , Policlinico S.Orsola - Malpighi University of Bologna , Bologna , Italy
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18
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Bazargani F, Jönson-Ring I, Nevéus T. Rapid maxillary expansion in therapy-resistant enuretic children: An orthodontic perspective. Angle Orthod 2015; 86:481-6. [PMID: 26270462 DOI: 10.2319/051515-329.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate whether rapid maxillary expansion (RME) could reduce the frequency of nocturnal enuresis (NE) in children and whether a placebo effect could be ruled out. METHODS Thirty-four subjects, 29 boys and five girls with mean age of 10.7 ± 1.8 years suffering from primary NE, were recruited. All subjects were nonresponders to the first-line antienuretic treatment and therefore were classified as "therapy resistant." To rule out a placebo effect of the RME appliance, all children were first treated with a passive appliance for 4 weeks. Rhinomanometry (RM), acoustic rhinometry (AR), polysomnographic registration, and study casts were made at different time points. RESULTS One child experienced severe discomfort from the RME appliance and immediately withdrew from the study. Following RME, the long-term cure rate after 1 year was 60%. The RM and AR measurements at baseline and directly after RME showed a significant increase in nasal volume and nasal airflow, and there was a statistically significant correlation between reduction in enuresis and increase in nasal volume. Six months postretention, a 100% relapse of the dental overexpansion could be noted. CONCLUSIONS RME has a curative effect in some children with NE, which could be connected to the positive influence of RME on the sleep architecture. Normal transverse occlusion does not seem to be a contraindication for moderate maxillary expansion in attempts to cure NE in children.
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Affiliation(s)
- Farhan Bazargani
- a Senior Consultant, Postgraduate Dental Education Center, Department of Orthodontics, Örebro, Sweden
| | - Ingrid Jönson-Ring
- b Senior Consultant, Public Dental Service, Uppsala County Council, Department of Orthodontics, Uppsala, Sweden
| | - Tryggve Nevéus
- c Associate Professor, Senior Consultant in Paediatric Nephrology, Department of Women's and Children's Health, Uppsala University, Uppsala University Children's Hospital, Uppsala, Sweden
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19
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Allen-Blevins CR, Sela DA, Hinde K. Milk bioactives may manipulate microbes to mediate parent-offspring conflict. Evol Med Public Health 2015; 2015:106-21. [PMID: 25835022 PMCID: PMC4512713 DOI: 10.1093/emph/eov007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/24/2015] [Indexed: 02/06/2023] Open
Abstract
Among mammals, milk constituents directly influence the ecology of the infant's commensal microbiota. The immunological and nutritional impacts of breast milk and microbiota are increasingly well understood; less clear are the consequences for infant behavior. Here, we propose that interactions among bioactives in mother's milk and microbes in the infant gut contribute to infant behavioral phenotype and, in part, have the potential to mediate parent-offspring conflict. We hypothesize that infant behavior likely varies as a function of their mother's milk composition interacting with the infant's neurobiology directly and indirectly through the commensal gut bacteria. In this article, we will explore our hypothesis of a milk-microbiota-brain-behavior dynamic in the context of the coevolution between human milk oligosaccharides, bacteria, the gut-brain axis and behavior. Integrating established features of these systems allows us to generate novel hypotheses to motivate future research and consider potential implications of current and emerging clinical treatments.
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Affiliation(s)
- Cary R Allen-Blevins
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA; Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA; Department of Organismal and Evolutionary Biology, University of Massachusetts, Morrill Science Center, Amherst, MA 01003, USA; Brain, Mind, and Behavior Unit, California National Primate Research Center, UC Davis, Davis, CA 95616, USA
| | - David A Sela
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA; Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA; Department of Organismal and Evolutionary Biology, University of Massachusetts, Morrill Science Center, Amherst, MA 01003, USA; Brain, Mind, and Behavior Unit, California National Primate Research Center, UC Davis, Davis, CA 95616, USA Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA; Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA; Department of Organismal and Evolutionary Biology, University of Massachusetts, Morrill Science Center, Amherst, MA 01003, USA; Brain, Mind, and Behavior Unit, California National Primate Research Center, UC Davis, Davis, CA 95616, USA
| | - Katie Hinde
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA; Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA; Department of Organismal and Evolutionary Biology, University of Massachusetts, Morrill Science Center, Amherst, MA 01003, USA; Brain, Mind, and Behavior Unit, California National Primate Research Center, UC Davis, Davis, CA 95616, USA Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA; Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA; Department of Organismal and Evolutionary Biology, University of Massachusetts, Morrill Science Center, Amherst, MA 01003, USA; Brain, Mind, and Behavior Unit, California National Primate Research Center, UC Davis, Davis, CA 95616, USA
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Jayadevappa R, Newman DK, Chhatre S, Wein AJ. Medication adherence in the management of nocturia: challenges and solutions. Patient Prefer Adherence 2015; 9:77-85. [PMID: 25609929 PMCID: PMC4298292 DOI: 10.2147/ppa.s51482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Nocturia affects millions of men and women. No prior reviews or meta-analyses have explored the issue of adherence in nocturia patients. The objective of our study was to examine the attributes and their interaction that might impact pharmacological adherence in nocturia care using a conceptual model of adherence. MATERIALS AND METHODS A literature search of the Medline, PubMed, Embase, PsycInfo, and CINAHL databases for studies published between January 1990 and June 2014 was conducted. We developed a conceptual model in order to facilitate our review. RESULTS Currently, multiple treatment options for nocturia exist, depending on the underlying cause. Adherence to nocturia treatment and outcomes are complex and intertwined, and nonadherence to nocturia treatment is common. In 15 studies meeting eligibility criteria, behavioral and pharmacologic interventions for nocturia were associated with reduced nocturia symptoms. Urinary symptoms that are associated with nocturia need individualized management depending on renal and hepatic function, medical comorbidities, and ongoing medication use in a patient. Another important factor related to adherence is the bother. Although nocturia is defined as nighttime-voiding frequency of one or more, not all persons may find this bothersome. The degree of bother is subjective, and may change from person to person. However, there is no information related to the association between bother and adherence to medication or behavioral treatments for nocturia. Medication dosing convenience, preference, and cost play important roles in adherence. We present a patient-centered conceptual model that brings together the various dimensions of medication adherence for nocturia. CONCLUSION Few studies have explored adherence to medication and related factors in the care of nocturia. Our conceptual model can aid development of interventions to improve adherence to nocturia medications.
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Affiliation(s)
- Ravishankar Jayadevappa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alan J Wein
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ondansetron and probiotics in the management of pediatric acute gastroenteritis in developed countries. Curr Opin Gastroenterol 2015; 31:1-6. [PMID: 25333367 DOI: 10.1097/mog.0000000000000132] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Acute gastroenteritis (AGE) is a common and impactful disease, typically managed with supportive care. There is considerable interest in the role of adjunctive therapies, particularly ondansetron and probiotics in improving AGE outcomes. The purpose of this review is to present the latest evidence regarding the use of these agents in children with AGE in developed countries. RECENT FINDINGS Single-dose oral ondansetron is effective and safe in reducing hospital admissions and the use of intravenous rehydration in children with AGE in emergency-department-based trials. Ondansetron use has increased significantly; however, 'real-world' studies of effectiveness have documented less impressive clinical impacts. Similarly, probiotic consumption is growing rapidly. Although several strains appear to reduce the duration of diarrhea in hospitalized children, current data are insufficient to support the routine use of probiotics in outpatient pediatric AGE. SUMMARY Ondansetron and probiotics may improve patient outcomes in pediatric AGE. Appropriate strategies are needed to optimally integrate oral ondansetron into clinical practice to maximize its potential benefits. Although probiotics remain a promising option, there are challenges in generalizing the data available to patients presenting for outpatient care. Large randomized controlled trials are needed to definitively guide the clinical use of probiotics in outpatients in developed countries.
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Nevéus T, Leissner L, Rudblad S, Bazargani F. Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis. Acta Paediatr 2014; 103:1187-91. [PMID: 25040246 DOI: 10.1111/apa.12749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/12/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022]
Abstract
AIM According to a number of small case series, orthodontic treatment may have anti-enuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children's nocturnal respiration and nasal airway dimensions. METHODS Children with therapy-resistant enuresis underwent polysomnography, focusing on nocturnal respiration, and had their nasal airways examined. Rapid maxillary expansion was performed, widening the maxilla by approximately 0.5 cm. The dental appliance was removed after 6 months. Enuresis frequency was evaluated four times: at baseline, with the orthodontic apparatus in situ, after completed maxillary expansion and 1 year post-treatment. RESULTS Of the 34 children recruited, one dropped out due to oral discomfort. The numbers of wet nights per week on the four assessment occasions were 5.48 ± 1.48, 5.12 ± 1.73, 3.09 ± 2.49 and 2.63 ± 2.81; p < 0.001. The proportions of responders, intermediate responders and non-responders during treatment were 21.2%, 27.3% and 51.5%, respectively. Responders were found to have a lower enuresis frequency at baseline (p = 0.001) and to have larger nasal airway dimensions (p = 0.01). CONCLUSION Orthodontic widening of the palate may be curative in a subgroup of children with therapy-resistant enuresis.
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Affiliation(s)
- Tryggve Nevéus
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | | | - Farhan Bazargani
- Department of Orthodontics; Postgraduate Dental Education Center; Örebro Sweden
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