Effectiveness of oral desmopressin therapy in posterior urethral valve patients with polyuria and detection of factors affecting the therapy

OBJECTIVES: The present study aims to evaluate the effect of desmopressin treatment on urine output, density and glomerular filtration rate (GFR) in patients with posterior urethral valve (PUV) and the factors affecting the response to this treatment. METHODS: A total of 68 PUV patients who were followed-up after valve ablation were examined with the fluid intake, urine output and GFR. Sixteen patients who were polyuric (a urine output more than 30 ml/kg/day) and had hypoosmolar urine (urinary density of 1015 or lower) included in the study. Blood chemistry and serum ADH level were studied. Following 5 days of observation, patients were given DDAVP perorally with a dosage of 0.4 mg/day, two equal doses per day. After 7 days and after a 3 month period of treatment, voiding characteristics, day-time and night-time urine densities and also GFR have been re-evaluated. RESULTS: The mean age was 6.8 years (range 2 to 11 years). The mean age at valve ablation was 20.7 months (range 5 months to 6 years). The mean daily urine output during first week and at the third month of the treatment had decreased significantly (p=0.004 and p=0.006). There was increase in night-time and day-time urine density in 10 patients (62%) and in 13 patients (81%) respectively at the third month evaluation. Increments in urine density were statistically significant for the third month evaluation. Nine (56%) patients had ADH levels within normal (<7 pcg/ml) levels and 7 patients had higher levels. There was no statistically significant difference between pretreatment and posttreatment micturation characteristics. However patients with voiding dysfunction responded better to DDAVP treatment. CONCLUSIONS: Desmopressin treatment improves polyuria in PUV patients. The responses are better particularly in PUV patients with significant bladder dysfunction. This supports the harmful role of polyuria on bladder dysfunction. The DDAVP treatment improves the day-time and night-time in PUV patients. Combination of DDAVP treatment with overnight catheterization may be a good alternative that needs to be evaluated by further prospective randomized studies.     

Impact of pneumococcal polysaccharide vaccine (Prevnar) on middle ear fluid in children undergoing tympanostomy tube insertion

OBJECTIVES: The purpose of this study was to describe the bacteriology of middle ear effusions in children who have received the pneumococcal polysaccharide vaccine (Prevnar) compared with unvaccinated children. METHODS: A prospective review of medical records from July 2001 to July 2002 was conducted on children with middle ear effusion at time of tympanostomy tube insertion. Middle ear fluid was plated onto culture media immediately after acquisition, and antimicrobial resistance of cultured organisms along with serotyping of Streptococcus pneumoniae was examined. Vaccination status, demographics, and risk factors were determined from patients' medical records, parent interviews, or contact with their primary care physicians. RESULTS: After adjusting for age and number of previous infections, children vaccinated with Prevnar are two times less likely to have non-S. pneumoniae pathogenic bacteria isolated than children not vaccinated. Of those with growth, vaccinated children were almost three times more likely than nonvaccinated children to have the presence of H. influenzae. Vaccinated children with H. influenzae were 7.5 times less likely to have beta-lactamase producing H. influenzae than nonvaccinated children with H. influenzae. CONCLUSION: Because the incidence of S. pneumoniae was low, no inference could be made whether Prevnar decreased otitis media with effusion or recurrent acute otitis caused by the S. pneumoniae serotypes covered by the vaccine. However, vaccinated children did appear to have the unexpected benefit of having a certain level of protection to growth of typical acute otitis media pathogens.     

Effects of aging on beta-carotene and vitamin A status

Symposium paper: Aging and Nutrition. Presented on October 5, 1990 during the 20th Annual Meeting of AGE in New York City.     

Antiplatelet agents: current drugs and future trends

Antiplatelet drugs in clinical use are discussed in terms of their mechanisms of action and the relevancy of that to the physiology of platelets and the pathophysiology of arterial thrombosis. Current clinical usage is outlined in detail for each drug. Experimental antiplatelet drugs also are discussed.     

Lunamarin C,a new terpenoid coumarin from Clausena heptaphylla

The petroleum ether extract of the leaves of Clausena heptaphylla afforded a new coumarin, lunamarin C (1). Its structure was determined by extensive analysis of spectral data, including 2D NMR and by comparison with structurally related compounds, lunamarins A (2) and B (3).     

Tactile discrimination task not disturbed by thalamic stimulation

The major pathway of human somatosensation passes through the ventrocaudal nucleus (Vc) of the thalamus. We tested the effect of direct electrical stimulation of the Vc on tactile discrimination in 5 Parkinson patients undergoing stereotactic thalamotomy. Raised gratings with lines 3, 4, or 6 mm apart were used. Patients had to actively touch test patterns placed in the hand contralateral to the thalamus under operation and compare it with a reference 3-mm grating held continuously in their other hand. Their performance was best for 6-mm, followed by 3-mm and then by 4-mm patterns regardless of electrical stimulation. Under Vc stimulation, patients recognized the 4-mm gratings slightly better. This can be explained either by the nature of thalamocortical interaction, which makes it resistant to external noise, or by the involvement of other pathways that circumvent the effect of thalamic stimulation.     

The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) for low back disorders: a validation study from Iran

BackgroundLumbar disc hernia (LDH) and lumbar spinal stenosis (LSS) are the most common diagnoses of low back and leg pain symptoms. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is a measure of health-related quality of life in these patients. This study aimed to cross-culturally translate and validate the JOABPEQ in Iran.MethodsThis was a prospective clinical validation study. The translation and cross-cultural adaptation of the original questionnaire was performed in accordance with published guidelines. A total of 103 patients with LDH or LSS were asked to respond to the questionnaire at two points in time: pre- and postoperative assessments (6 months follow-up). To test reliability, the internal consistency was assessed by Cronbach's alpha coefficient, and validity was assessed using convergent validity. Responsiveness to change was also assessed comparing patients' pre- and postoperative scores.ResultsThe Cronbach's alpha coefficients for the JOA-BPEQ at pre- and postoperative assessments ranged from 0.71 to 0.81, indicating a good internal consistency for the questionnaire. In addition, the correlation of each item with its hypothesized subscale of the JOABPEQ showed satisfactory results, suggesting that the items had a substantial association with the subscale representing the concept. Further analysis also indicated that the questionnaire was responsive to change (P < 0.0001).ConclusionsIn general, the Iranian version of JOABPEQ performed well, and the findings suggest that it is a reliable and valid measure of back pain evaluation among LDH and LCS patients.