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Urinary excretion of N-acetyl-beta-D-glucosaminidase and epidermal growth factor in paediatric patients receiving cefixime prophylaxis for recurrent urinary tract infections
No full textObjective: To determine the urinary excretion of N-acetyl-beta -D-glucosaminidase (NAG; early index of renal proximal tubular damage) and epidermal growth factor (EGF; early index of renal damage repair) in paediatric patients with and without vesico-ureteric reflux (VUR) receiving prophylactic cefixime for recurrent urinary tract infections (UTIs).
Design and Setting: Urinary levels of NAG and EGF in children, with and without VUR, with recurrent UTIs receiving prophylactic cefixime were compared with normal paediatric laboratory values in a university paediatric department. All children were followed during an ordinary admission or in a day hospital.
Participants and Treatment: The study population consisted of 27 patients (15 males, 12 females; mean age 1.73 +/- 1.43 years) followed in the Paediatric Department of the University of Verona for recurrent UTIs. All patients had experienced at least two episodes of UTIs in the previous 2 months. Patients received antibiotic prophylaxis with cefixime (4 mg/kg bodyweight), administered as a single bedtime dose. The overall duration of the treatment ranged from I to 2 months. Urine samples and cultures were taken immediately prior to voiding urethrocystography via the bladder catheter and were immediately frozen at -20 degreesC. NAG activity and EGF levels in the urine were determined using a colorimetric assay and a radioimmunoassay, respectively. The urinary creatinine level was determined using the Jaffe kinetic colorimetric method at a constant reaction temperature of 37 degreesC. The values obtained were compared with the Laboratory's own reference standards for paediatric patients.
Main Outcome Measures and Results: All children in the study population presented with normal routine laboratory values, in particular serum creatinine and BUN levels. In addition, urine tests and cultures yielded normal values in III cases. In patients without VUR receiving prophylactic cefixime, the mean [ standard deviation (SD)] NAG level was 0.50 +/- 0.30 U/mmol creatinine (range 0.05 to 1.17). Only one of 20 patients had a slight increase above the normal range. In patients with VUR, the urinary NAG level was 2.55 +/- 1.66 U/mmol creatinine (range 1.37 to 6), with all seven patients having abnormally elevated NAG values. The difference in NAG levels between the two groups was statistically significant (p g/L (range 1.58 to 49.63). In patients receiving prophylaxis with cefixime with VUR treatment (group 2), the mean (+/- SD) urinary EGF level was 38.23 +/- 33.99 mug/L (range 14.4 to 107). Urinary EGF levels were not statistically different between group I and normal levels, whereas in group 2, EGF levels were significantly higher than normal levels or those of group I (p < 0.05, both comparisons).
Conclusions: Prophylactic treatment with cefixime was well tolerated, including renally, in children with recurrent UTIs without VUR. Renal tolerability was assessed using a sensitive measure of the early signs of nephrotoxicity, such as urinary NAG values, and markers of damage repair, such as urinary EGF levels. The presence of VUR in patients was associated with significant renal proximal tubular damage, as reflected in elevated urinary NAG values. The high urinary EGF values probably reflect the compensatory repair action of the kidney in patients with VUR. In conclusion, in clinical practice, cefixime may be safely suggested for antibiotic prophylaxis in paediatric patients with recurrent UTIs
C-reactive protein and serum amyloid A protein in neonatal infections
No full textIn this study, we examine C-reactive protein (CRP) and serum amyloid protein A (SAA). Although the former is the best known and most commonly used indicator of inflammation, certain considerations underline the inadequacy of CRP determination alone for the early diagnosis of infection. In fact symptoms often precede the CRP elevation. SAA protein comprises a family of polymorphic apolipoproteins produced mainly by the liver. and several studies have stressed its importance in the diagnosis and monitoring of various diseases. Pathological SAA values are often detected in association with normal CRP concentrations. SAA rises earlier and more sharply than CRP. Finally, contrary to CRP, SAA presents the same trend in viral as well as bacterial infections. Although the data available on SAA in neonates are currently very limited, it is possible to postulate a role of primary importance for SAA in the management of neonatal infections
Urinary epidermal growth factor in different renal conditions in children
No full textSeveral studies have demonstrated the important role of growth factors; particularly epidermal growth factor (EGF) and transforming growth factor alpha (TGF alpha), in cellular growth after renal damage. EGF is mainly synthesized by the kidney. Many studies indicate that urinary EGF concentration significantly decreases in patients with acute and chronic renal failure. In this study we determined urinary EGF concentrations in children with renal and/or urological pathologies. We investigated 38 patients, 17 males and 21 females, of 3.34 +/- 2.96 years (mean +/- standard deviation), who were followed in the Nephrologic Unit of the Pediatric Department of the University of Verona for recurrent urinary tract infections: seven of these had vesicoureteric reflux and 4 had hypodysplasia. The results were compared with those from a healthy age-matched group of 44 children. In all patients, we assessed renal function including an examination of the urine with a microbiological evaluation. Moreover, a renal ultrasound: and a voiding cystourethrogram were performed. Urinary EGF was measured by a radioimmunoassay, using polyclonal goat antibodies. In all patients, laboratory parameters were within the normal range. In 34 patients the renal ultrasound was negative and in 4 cases structural alterations of the renal parenchyma were found. Voiding cystourethrography detected 7 instances of vesicoureteric reflux. In controls 10 degrees, 50 degrees, 90 degrees percentile uEGF values were 7.3, 19 and 40.4 mug/L, respectively. Mean urinary EGF values were 22.22 +/- 16 mug/L. Urinary EGF values were 54 +/- 35.2 mug/L in patients with recurrent urinary tract infections and without urinary malformations, 81 +/- 29.37 mug/L in patients with vesicoureteric reflux and 22.30 +/- 22.90 mug/L in patients with hypodysplasia, respectively: There was a statistical significant difference between controls and groups A (p < 0.001) and B (p < 0.001) respectively, while the difference between group C and controls wasn't significant (p = 0.044). Results are reported in Figure 1. We believe that our results could be helpful for further studies on pathophysiology of growth factors in different renal conditions of children
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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