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Corynebacterium urealitycum is a gram-positive bacillus, usually found as a colonizer on the skin. However, a pathogenic role has been described in susceptible patients, where it can cause urinary tract infection, nephrolithiasis, pyelitis, and encrusted cystitis., Methods: Retrospective cohort study of patients older than 18 years with positive urine cultures for C. urealyticumin the Laboratory of the Microbiology of the UC Health Network - CHRISTUS, between 2017 and 2020., Results: 6 positive urine cultures were obtained, corresponding to 5 patients. One case presented as encrusted pyelitis, with an associated reinfection, one case as lower urinary tract infection, and three as asymptomatic bacteriuria. All patients had some relevant risk factor. All patients presented urine tests with triple phosphate crystals and alkaline pH between 7.5 and 9.0., Conclusions: Patients with positive urine cultures for C. urelyticum represent a low percentage of all agents isolated from urine cultures. Although it may be asymptomatic, the development of encrusted pyelitis is a possible manifestation associated with an extended hospital stay. Urinalysis with alkaline pH and the presence of triple phosphate crystals is characteristic. More extensive clinical series and antibiotic susceptibility studies are necessary for a more standardized management of these patients. Finally, the authors' key lesson is remembering how unusual bacteria, such as C. urealyticum, can cause serious complications secondary to their phytopathogenic mechanism of urine alkalinization.

Objective: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED)., Methods: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value., Results: A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of ≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value., Conclusion: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

In 2015, the "New recommendations regarding the current controversies in urinary infection" were published in the Archivos Argentinos de Pediatría. Given the fact that in these past years, new evidence has emerged regarding the diagnosis and treatment of urinary infection, the Pediatric Nephrology Committee of Sociedad Argentina de Pediatría has decided to update these recommendations. The main goal is to provide the pediatrician with the necessary tools to make a correct diagnosis, define the most appropriate treatment, select the patients who will benefit from antibiotic prophylaxis, and decide which imaging studies will be necessary, avoiding costly and invasive interventions. These guidelines also include the management of children with urinary tract infections associated with special situations such as: bladder bowel dysfunction, the newborn, children with neurogenic bladder, kidney transplant patients and fungal urinary tract infections., Competing Interests: None., (Sociedad Argentina de Pediatría.)

Kidney abscess is an unusual entity in childhood with few studies about its clinical characteris tics., Objective: To report the clinical presentation, diagnosis, and therapy used in a cohort of 20 children with kidney abscess., Patients and Method: retrospective study of cases of kidney abscess during a 10-year period at the Hospital Roberto del Río. The analysis of clinical, laboratory, and imaging characteristics were evaluated as well as the treatment usedfor this condition., Results: 20 cases were reported among which 65% were women with a median age of 3.6 years. The most com mon clinical presentation was fever, vomit, and dysuria. Eighty percent of patients presented an increase of inflammatory parameters, 88% presented positive urine culture, and the most common organism identified was Escherichia Coli (77.8%). The diagnosis was mostly made through kidney ultrasound (75%) followed by an abdominal CT scan (35%). 93% of abscesses were unilateral. About 95% of the patients only required antibiotic treatment. Vesicoureteral reflux was diagno sed in 28% of the patients with no sphincter control, and only one of them presented high-grade reflux. In patients with sphincter control, bladder and bowel dysfunction (BBD) was diagnosed in 90% of the cases. Forty four percent of the patients with late DMSA renal scintigraphy presented renal scarring., Conclusions: In this series, pediatric kidney abscess appears with persistent fever despite the treatment, requiring prolonged antibiotic therapy and rarely surgical drains. We su ggest a study aimed at detecting modifiable factors, such as vesicoureteral reflux in patients with no sphincter control and BBD in patients with sphincter control, as well as identifying renal paren chymal sequels in all patients.

Introduction: Acute fever of unknown origin (FUO) in children under 29 days is a worrying situation because of the risk of serious bacterial infection (SBI)., Objective: to study the main clinical and laboratory characteristics of a group of hospitalized children under 29 days with diagnosis of FUO., Patients and Method: Retrospective study of children under 29 days hospitalized due to FUO. The clinical records of the patients were reviewed, recording age, sex, history of fever before consultation, temperature at admission, estimated severity at admission and discharge, discharge diagnoses, laboratory tests, and indicated treatments. Patients were classified according to the severity of the discharge diagnosis, as severe (S) and non-severe (NS). The inclusion criteria were term newborn, age less than 29 days, fe ver > 38°C registered at home or admission, and history of < 4 days., Results: 468 children with FUO were admitted. Concordance between severity at admission and discharge was low (Kappa = 0.125; p = 0.0007). 26.1% of children were S and 73.9% NS. In the S group, urinary tract infection domínate (70.5%) and in the NS, FUO (67.6%). The cut-off levels for leukocytes/mm3, C-reactive protein, and neutrophils/mm3 showed negative predictive values to rule out severe bacterial infection. Conclu sions: Most of the newborns presented mild severity at admission, but 24% of them had SBI, thus hospitalization and close clinical observation are always necessary. Laboratory tests, such as CRP, white blood cell and neutrophils count are not good predictors of SBI. Early treatment with antibio tics for patients who meet the low-risk criteria is debatable.

Introduction: Acute focal bacterial nephritis is an interstitial bacterial infection, localised in the renal parenchyma, which can be more serious than acute pyelonephritis. The aim of this study is the analysis of predictive factors that may lead to its early diagnosis, which is essential for an adequate therapeutic approach., Patients and Methods: A retrospective, multicentre case and control study. The participant centres were hospitals in Castellon and Valencia. The study period was 2010-2018, with the cases being patients with focal bacterial nephritis and the patients with pyelonephritis as controls., Results: A total of 158 (1:1) patients were included. The median age of the cases was 2 years and there were 75% females. There were no differences in the clinical presentation. In the univariate analysis, focal nephritis was associated with malformations of the urinary tract, bacteraemia, the neutrophil count, and procalcitonin, as well as febrile convulsions of borderline significance. Procalcitonin values ≥2 ng/ml had an OR of 4.9 (95%CI; 1.77-13.85) of presenting with focal nephritis. In the multivariate analysis, the urological malformations still maintained statistical significance and borderline significance for procalcitonin., Conclusions: The urinary tract malformations predispose the development of focal bacterial nephritis. In patients with a urinary tract infection and predictive factors of acute focal bacterial nephritis it would be worthwhile performing a renal Doppler ultrasound in the acute phase for its appropriate diagnosis and treatment., (Copyright © 2020 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS)., Methods: A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated., Results: Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at maximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD)., Conclusions: The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor.

Objective: to analyze the in-hospital complications of prolonged hospital stay in patients with ischemic stroke or transient ischemic attack, admitted to the stroke unit of a tertiary hospital., Method: this is an evaluative correlational study. All first-ever ischemic stroke or transient ischemic attack patients admitted were retrospectively analyzed. During hospital stay, the predictors of long-term hospitalization considered were: 1) clinical complications (pneumonia, urinary tract infection, pressure damage and deep vein thrombosis), and 2) neurological complications (malignant ischemic stroke and symptomatic hemorrhagic transformation)., Results: 353 patients were discharged in the study period. Mean age was 64.1±13.7 years old and 186 (52.6%) were men. The mean time of hospital stay was 13.7±14.3 days. Pneumonia (25.3±28.8 days, p<0.001), urinary tract infection (32.9±45.2 days, p<0.001) and malignant stroke (29.1±21.4 days, p<0.001) increased significantly the length of hospital stay compared to patients without any complications (11.2±7.1 days)., Conclusion: this study showed that three complications delayed hospital discharge in patients admitted in a stroke unit, two preventable ones: pneumonia and urinary tract infection. More intense measures to avoid them should be included in the performance indicators to reduce the length of hospital stay in stroke units.

Objective: First to identify the areas of improvement in the surgical area before and during the performance of a surgical procedure in general surgery through the application of a Modal Analysis of Failures and Effects. Second to establish preventive measures to avoid adverse events in the surgical area., Method: A multidisciplinary working group was created in a university hospital for risk management in the General Surgery Operating Room Unit. The Modal Analysis of Faults and Effects was used. Potential risks for the patient in the ante-surgery and within the operating room were identified. The Risk Priority Index was calculated and preventive measures were established for all of them, with special interest when the Risk Priority Index was higher than 100. Preventive measures were developed based on the detected risks as well as those responsible for them., Results: We identified a greater number of risks when the patient is in the operating room than in the ante-surgery room. Those with a higher risk priority index were: anticoagulated or antiaggregated patients, urinary tract infections, osteoarticular or neuropathic problems, patients not prepared for colon surgery, errors in laterality and leaving compresses in the operative field., Conclusions: A risk map has been developed in our organization, allowing the design of strategies to improve Patient Safety in the Surgical area. Training is a key aspect to improve Patient Safety., (Copyright © 2019 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Nosocomial bacteremia secondary to urinary tract infections (NBS-UTI) occur in 1-4% of episodes and the associated mortality can increase up to 33%. However, very little is known about the epidemiology of these infections. The determination of modifiable risk factors to develop this type of bacteremia could help to control the infection and reduce health costs., Methods: Cases-control study of NBS-UTI diagnosed at the University Hospital of Canary Islands between 2010-2014. The clinical-epidemiological variables and the intrinsic and extrinsic potential risk factors were collected. Logistic regression was used to study the variables associated with the development of NBS-UTI., Results: A total of 178 episodes were studied, 85 cases and 93 controls. The average stay was significantly greater in the cases; from admission to bacteremia (p <0.003), as well as from discharge to discharge (p <0.005). Hepatic insufficiency (p <0.091), the use of mechanical ventilation (p <0.001), the central venous catheter (p <0.043) and surgery in the episode (p <0.001) behaved as risk factors for the acquisition of NBS-ITU., Conclusions: Invasive devices, such as central venous catheter and mechanical ventilation, that had not previously been studied; as well as the surgery in the episode, which had not been studied either, suppose risk factors. In addition, NBS-ITU causes a significant increase in hospital stay. Therefore, it is necessary to know the risk factors for the appearance of these infections, and thus prevent their appearance and improve the safety of hospitalized patients., (©The Author 2019. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Objective: To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department., Methods: This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality., Results: The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p < 0.001), skin and soft tissues (OR 2.6; 95%CI, 1.4 - 5.0; p = 0.003), bloodstream (OR 2.0; 95%CI, 1.1 - 3.6; p = 0.018), without specific focus (OR 2.0; 95%CI, 1.1 - 3.8; p = 0.028), and intra-abdominal focus (OR 1.9; 95%CI, 1.1 - 3.3; p = 0.024)., Conclusions: There is a significant association between the different sites of infection and in-hospital mortality or the need for admission to an intensive care unit in patients with sepsis or septic shock. Urinary tract infection shows the lowest risk, which should be considered in prognostic models of these conditions.

Introduction: The aim was to investigate the relationship between vesicoureteral reflux (VUR) and renal damage in non-febrile, febrile for the first time and recurrent urinary tract infection (UTI) patients. The secondary aim was to determine whether C-reactive protein (CRP) in febrile UTIs could be a predictor of renal scarring., Population and Methods: This prospective study included non-febrile, febrile for the first time and recurrent pediatric UTI cases. The routine lab analyses comprised a complete blood count, urea, creatinine, fully automated urinalysis, urine culture and CRP analyses. All the participants were examined using urine ultrasonography subsequent to their UTI diagnosis, voiding cystourethrography (VCUG) after six weeks and Tc-99m dimercaptosuccinic acid (DMSA) static renal scintigraphy after six months., Results: There were included 47 children with non-febrile UTIs, 48 with first febrile UTIs and 61 with recurrent UTIs. A statistically significant difference was found among the groups in terms of VUR and renal scarring (p= 0.001 and p= 0.011, respectively). A statistically significant difference was also found in terms of renal scarring between patients with and without VUR (p= 0.001). Moreover, a statistically significant difference was also present in relation to renal scarring (p <0.05) in patients with five-fold lower or higher CRP values than the accepted cut-off value (5mg/dl)., Conclusion: The ratio of renal scars detected was found to be parallel to the VUR frequency. The higher the VUR grade, the more renal damage was found. A positive correlation between elevated CRP and renal scarring was determined, indicating the presence of scarring during the diagnosis of pyelonephritis., (Sociedad Argentina de Pediatría.)

Objectives: Because of high rates of resistance to fluoroquinolones, ceftriaxone has become one of the main options for treating febrile urinary tract infection (FUTI). This study aimed to identify predictors of ceftriaxone resistance in community-acquired FUTIs in men., Material and Methods: Cross-sectional ambispective study enrolling men with FUTIs treated in the emergency department of a local area hospital in Spain., Results: A total of 552 FUTI episodes were studied; 103 (18.6%) were caused by a ceftriaxone-resistant microorganism. Variables associated with a ceftriaxone-resistant FUTI were older age, health care-associated FUTI, dementia, diabetes mellitus, neoplasms, a history of UTIs, urologic disease, and complicated FUTI. Patients with ceftriaxone-resistant FUTIs also had higher rates of recent antibiotic treatment. Independent variables associated with FUTI due to a ceftriaxoneresistant microorganism were cirrhosis of the liver (odds ratio [OR], 6,00 95% CI, 1.25-28; P = .025), health careassociated FUTI (OR, 2.3 95% CI, 1.23-4.27; P = .009), and prior treatment with antibiotics (OR, 2.15; 95% CI, 1.23-3.76 P = .007). Components of health care-associated FUTI were a history of admission to a long-term residence (OR, 2.90 95% CI, 1.21-7.16; P = .017) and use of penicillins with or without beta-lactamase inhibitors (OR, 2.16; 95% CI, 1.05-4.42; P = .035)., Conclusion: Cirrhosis of the liver; history of health care-associated FUTI, especially in patients residing in a long-term care facility; and recent use of antibiotics, mainly penicillins with or without beta-lactamase inhibitors, are risk factors for ceftriaxone-resistant FUTI in men.

Antecedentes: La gangrena de Fournier (GF) es una fascitis necrotizante que pone en peligro la vida del paciente. El objetivo de este trabajo fue determinar la etiología y el impacto del agente aislado en el cultivo de la herida y de orina., Método: Se llevó a cabo un análisis retrospectivo de una cohorte de 66 pacientes con GF de origen urogenital. Los valores cualitativos medidos se expresaron como frecuencia y porcentaje, y se compararon con la prueba de ji al cuadrado y la prueba de Fisher. La diferencia se consideró estadísticamente significativa con p < 0.05., Resultados: Los pacientes que murieron presentaban con mayor frecuencia cultivos de orina y herida positivos para Escherichia coli productora de betalactamasas de espectro extendido (BLEE): orina, sobrevivientes 14.5% vs. muertes 44.4%; herida, sobrevivientes 20.8% vs. muertes 66.6% (p < 0.001)., Conclusiones: Durante la valoración integral del paciente con GF es fundamental realizar cultivos de orina y de herida con el fin de iniciar el manejo antibiótico dirigido de manera temprana. Los pacientes con GF que mueren presentan mayor número de cultivos positivos para E. coli BLEE., Background: Fournier gangrene (FG) is a necrotizing fasciitis that endangers the patient’s life. The objective of this study was to determine the etiology and impact of the agent isolated on wound and urine culture., Method: We performed a retrospective analysis within a cohort of 66 patients with FG of urogenital origin. The measured qualitative values were expressed as frequency and Percentage and compared with the chi square test and Fisher’s test. The difference was considered statistically significant at p < 0.05., Results: Patients who died had more frequent cultures of urine and wound positive for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli: urine, survivors 14.5% vs. deaths 44.4%; wound, 20.8% vs. 66.6% (p < 0.001)., Conclusions: During the integral evaluation of the patient with FG it is essential to perform the urine and surgical wound cultures in order to initiate the antibiotic management directed at an early stage. Patients with GF who die present a greater number of cultures positive for E. coli ESBL., (Copyright: © 2018 Permanyer.)

Elevated level of ammonia in the blood, defined as hyperammonemia, is feasible to cause neurological symptoms when crossing the blood-brain barrier. The most frequent and studied cause of hyperammonemia is liver failure. Nevertheless, other less frequent and known etiologies must be considered. Urinary tract infection caused by urea-splitting bacteria, despite being unusual in pediatric patients, must be taken into account. We report a pediatric patient with severe acute encephalopathy and high levels of ammonia in blood. After ruling out other causes of hyperammonemia, it was assumed secondary to urinary tract infection by Corynebacterium riegelii, a ureasplitting bacteria. General treatment for hyperammonemic encephalopathy was established, as well as specific treatment with antibiotics. The patient evolved favorably., (Sociedad Argentina de Pediatría.)

Primary biliary cholangitis (PBC) is a chronic autoimmune cholangiopathy characterized by a selective destruction of biliary epithelial cells of small and medium caliber hepatic ducts, which mainly affects women. The main symptoms are fatigue and pruritus, however, a large proportion of patients may be asymptomatic. The diagnosis is based on AMA titers >1:40, alkaline phosphatase >1.5 times the upper limit for more than 24 weeks and compatible liver histology. It is associated with multiple autoimmune diseases mainly extrahepatic, thyroid diseases, bone diseases, among others. The first line treatment is ursodeoxycholic acid (UDCA), that improves liver function tests and delay the progression to cirrhosis. Currently, there are new treatments and adjuvant therapies on study. The purpose of this review is to offer an update in this topic, which is very important in gastroenterology and internal medicine. We formed an interdisciplinary team to search in the database Medline thorough PubMed with the key words describe below, we made a critical lecture of the titles and abstracts of each article to write this paper.

Background: Epilepsy is the most common chronic neurological disease in the world. In Mexico, epilepsy is among the diseases more related to mortality due to non-infectious diseases in children. The objective of the study was to identify the factors associated with epilepsy in children entitled to the Mexican Social Security Institute (IMSS), in Acapulco, Mexico., Methods: We carried out a case-control study from April 2010 to April 2011. We selected 118 cases from the database of outpatient pediatric neurology with epilepsy diagnostic with two year of evolution according to the International League Against Epilepsy criteria. We selected 118 controls from the same Medical Units where cases were detected. Data collected throughout an interview with the mothers included information on history of epilepsy among relatives, prenatal, perinatal and postnatal history. Bivariate and multivariate analysis was performed using Mantel-Haenszel process., Results: Multivariate analysis identified three factors associated with epilepsy: family history of epilepsy in first-degree relatives (adjusted Odds ratio (ORa) 2.44, 95%CI 1.18 -5.03), birth asphyxia (ORa 2.20, 95%CI 1.16-34.18), and urinary tract infection in the prenatal stage (ORa, 1.80, 95%CI 1.0 - 3.24)., Conclusions: Preventing birth asphyxia and urinary tract infections during pregnancy reduces the risk of epilepsy regardless of the history of epilepsy in first-degree relatives., (Copyright © 2017 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.)

Objetives: To compare the diagnostic sensitivity, costs and radiation doses of imaging tests algorithms developed by the Argentine Society of Pediatrics in 2003 and 2015, against British and American guidelines after the first febrile urinary tract infection (UTI)., Population and Methods: Inclusion criteria: children ≤ 2 years old with their first febrile UTI and normal ultrasound, voiding cystourethrography and dimercaptosuccinic acid scintigraphy, according to the algorithm established by the Argentine Society of Pediatrics in 2003, treated between 2003 and 2010. The comparisons between algorithms were carried out through retrospective simulation., Results: Eighty (80) patients met the inclusion criteria; 51 (63%) had vesicoureteral reflux (VUR); 6% of the cases were severe. Renal scarring was observed in 6 patients (7.5%). Cost: ARS 404,000. Radiation: 160 millisieverts. With the Argentine Society of Pediatrics' algorithm developed in 2015, the diagnosis of 4 VURs and 2 cases of renal scarring would have been missed. The cost of this omission would have been ARS 301,800 and 124 millisieverts of radiation. British and American guidelines would have missed the diagnosis of all VURs and all cases of renal scarring, with a related cost of ARS 23,000 and ARS 40,000, respectively and 0 radiation., Conclusion: Intensive protocols are highly sensitive to VUR and renal scarring, but they imply high costs and doses of radiation, and result in questionable benefits., (Sociedad Argentina de Pediatría)

Background: An alternative treatment for obstructive and refluxing obstructive megaureter with ureterovesical junction maintenance through laparoscopy is proposed., Material and Methods: The series consists of 8 cases, all of them studied because of prenatal hydronephrosis or febrile urinary tract infection. Seven were diagnosed with obstructive megaureter and one with obstructive refluxing megaureter. The procedure consisted in incising the stenotic portion of the ureter longitudinally and maintaining its posterior wall attached to the bladder, the anterior wall of the ureter was anastomosed transversally to the bladder mucosa in order to liberate the obstruction., Results: Two of the 8 cases were women and 6 were male. They were aged between 5 months and 11 years (average age of 2.9 years). The surgical time varied between 90 and 120min, with a 48h hospital stay. The permanence of the vesical catheter and the double J stent was of 48h and 6 weeks, respectively. A female patient developed febrile urinary tract infection one week after the surgical procedure. The rest of the patients remained asymptomatic, with normal urinalysis and quarterly urine culture results. Six months after the procedure, the ultrasound showed improvement of the ureteral diameter and of the pyelocaliceal ectasia. The average follow-up was of 2 years., Discussion: The handling of stenosis with longitudinal incision of the ureter and transverse anastomosis to the bladder mucosa, seems promising. The laparoscopic approach allows to identify clearly the longitude of the stenotic segment and join with relative precision such opening with the one of the vesical mucosa., (Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.)

Objective: The aim of the study was to analyze the characteristics of patients with acute prostatitis presenting to the Emergency Department, the microbiological findings, antibiotic susceptibility, and bacteraemia associated factors., Methods: Observational and cohort study with prospective follow-up including patients with acute prostatitis presenting to the Emergency Department from January-December 2012. Data were collected for demographic variables, comorbidities, microbiological findings, antibiotic treatment and outcome., Results: Two hundred and forty one episodes of acute prostatitis were included. Mean age was 62.9 ± 16 years, a history of prostate adenoma was reported in 54 cases (22.5%) and prior manipulation of the lower urinary tract in 40 (17%). Mean symptoms duration was 3.38 ± 4.04 days, voiding symptoms were present in 176 cases (73%) and fever in 154 (64%). Seventy patients (29%) were admitted to the hospital and 3 died. From 216 urine cultures, 128 were positive (59%) and 24 (17.6%) out of 136 blood cultures. Escherichia coli was the main pathogen (58.6% of urine cultures and 64% of blood cultures) with resistant strains to fluoroquinolones, cotrimoxazole and amoxicillin/clavulanic in 27.7%, 22.9% and 27.7% of cases respectively. In the univariate analysis, only chills were associated to bacteraemia (p=0.013). At 30-day follow-up, patients with bacteraemia returned more frequently to the Emergency Department (p=0.037) and were more often admitted to the hospital (p=0.003)., Conclusions: Patients with acute prostatitis discharged from the Emergency Department need clinical follow-up and monitoring of microbiological findings in order to assure an adequate antibiotic treatment. Return to Emergency Department and admission to the hospital were significantly more frequent among patients with bacteraemia.

Basic renal function tests such as maximum urine osmolality and urinary elimination of albumin and N-acetyl-glucosaminidase often reveal abnormalities in clinical cases involving hyperpressure in the urinary tract or loss of renal parenchyma. However, in all the available algorithms dedicated to the study of children with urinary tract infection or dilation, the benefit of using these functional parameters is not mentioned. In this review, we provide information about the practical usefulness of assessing the basic renal function parameters. From these data, we propose an algorithm that combines morphological and functional parameters to make a reasoned case for voiding cystourethrography., (Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Corynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection., Study Objective: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years., Material and Methods: A descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy., Results: The total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009-2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6-9) vs. 6 (r, 5-7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6->90) vs. 52.7 (r, 13->90). The improvement in GFR was 6.94 points (T Wilcoxon; P=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU., Conclusions: The prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications., (Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs)., Methods: Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013., Results: The study included 328 patients diagnosed with UTI, with a mean age of 52±22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at .993 (95% CI .987-1; P<.001). A cutoff≥1.16ng/mL achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC-AUC of .844, and CRP achieved only .534. The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08±16.37 and .34±.37ng/mL, respectively (P<.001)., Conclusions: For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes., (Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Idiopathic hypercalciuria (IH) predisposes to urinary tract infections (UTIs); however, there is scarce local information regarding such association. Our objectives were to estimate IH prevalence in children with UTI and to assess whether there were differences in relation to the presence or absence of vesicoureteral reflux (VUR). Additionally, the association between IH and salt intake was studied., Population and Methods: Calciuria was determined in patients younger than 18 years old on whom UTI had been studied (ultrasound and voiding cystourethrogram), and who had no secondary causes of hypercalciuria. IH was defined as a calcium to creatinine ratio of >0.8, 0.6, 0.5 and 0.2 in children aged 0 to 6 months old, 7 to12 months old, 12 to 24 months old and older than 2 years old, respectively; and a high sodium intake with a urinary sodium to potassium ratio of >2.5., Results: IH prevalence among 136 patients (87 girls, median age: 3 years old) was 20%. Patients with VUR (n= 54) and without VUR (n= 82) had similar characteristics in terms of sex, weight, height, age at diagnosis and age at the time of the study, and clinical features (hematuria, nephrolithiasis, colicky pain, and recurrent UTI), family history of kidney stone formation, and IH prevalence (26% versus 16%, p= 0.24). A high sodium intake was more frequently observed in children with hypercalciuria than in those with normal urine calcium levels (76% versus 46%, p= 0.007)., Conclusions: IH prevalence in children with UTI was high (20%), with no differences observed between patients with and without VUR. As a recommendation, the presence of IH should be detected in children with UTI, regardless of VUR presence or absence.

Nephrobronchial fistula is a rare complication of kidney infections, usually occurring in adult patients with xanthogranulomatous pyelonephritis and very occasionally in children. We reported a 12-year-old girl, with a history of myelomeningocele and recurrent urinary tract infection, who presented with a four-week fever, cough and dyspnea, developing septic shock and presenting flood of airway by pus which caused cardiac arrest. A diagnosis of left perirenal extensive collection was established by abdominal computed tomography (CT). The patient first had antibiotic therapy and percutaneous drainage was performed draining pus and air. Thoracic and abdominal CT scan was performed corroborating transdiaphragmatic fistula. Total nephrectomy was performed. The patient showed gradual improvement after surgery and total regression of symptoms. Pathologic examination concluded chronic pyelonephritis. This case report illustrates a rare complication in children, the importance of early diagnosis of urinary tract infection in patients with comorbidities and of exhibiting a high index of suspicion to a potentially lethal complication.

Sepsis in patients with human immunodeficiency virus (HIV) may be associated with the appearance of cardiac dysfunction. This is a challenge, both when making the differential diagnosis and determining the proper treatment, as there are numerous risk factors: Myocarditis due to the HIV itself, the presence or absence of highly active antiretroviral therapy, toxic substances, and cardiomyopathy associated with sepsis. The diagnostic and therapeutic approach to an HIV positive patient with septic shock and cardiac dysfunction is described, as well as a brief review of the different causes of cardiomyopathy which may affect this group of patients is also presented., (Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

Objectives: To know the characteristics of vesical schistosomiasis caused by schistosoma hematobium in immigrant patients., Material and Methods: The retrospective study of 41 cases microbiologically diagnosed in our hospital over the last 16 years is presented. Data was collected on origin, age, presentation form, diagnostic tests and treatment., Results: All were African patients whose ages ranged from 4 to 32 years and who had terminal macroscopic hematuria. Most of the patients (85%) were men. In all of the cases, diagnosis was by a urinary microbiological study and in one case, cystoscopy with a biopsy of a typical vesical lesion. Terminal hematuria is the most representative clinical sign. They were treated with praziquantel., Conclusions: The epidemiology and intermittent terminal hematuria in African patients should lead to the suspicion of vesical schistosomiasis as the first diagnostic option. Urinary microbiological study is a rapid, non-invasive, test with high diagnostic yield that would avoid performing invasive studies. Its simple treatment assures high level of compliance and consequent efficacy., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Objective: To establish the utility of procalcitonin (PCT) and other clinical and analytical parameters as markers of acute and permanent renal damage in children after a first febrile urinary tract infection (UTI)., Methods: Retrospective multicentre study. Statistical study: descriptive, receiver operating characteristic (ROC) curves and multiple logistic regression., Results: 219 patients, aged between 1 week and 14 years (68% under 1 year). The mean PCT values were significantly higher in patients with acute pyelonephritis with respect to normal acute DMSA (4.8 vs 1.44; p=0.0001), without achieving that signification for late affected DMSA (6.5 vs 5.05; p=0.6). The area under the ROC curve for PCT was 0.64 (CI 95% 0.55-0.72) for acute renal damage, and 0.62 (CI 95% 0.44-0.80) for permanent damage, with optimum statistical cut-off values of 0.85 and 1.17ng/ml. Multivariate analysis for acute renal damage only found correlation with PCT (Odds Ratio [OR] 1.2 (CI 95% 1.06-1.4, p=0.005), and hours of fever (OR for less than 6 hours of fever 0.4 (CI 95% 0.2-1.02, p=0.05). In patients with renal scarring, PCT showed an OR 1.0 (CI 95% 0.9-1.1, p=0.6)., Conclusions: PCT and the duration of fever were the only parameters statistically associated with early renal damage. PCT and renal scarring did not reach statistical significance.

Introduction: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense., Material and Methods: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments., Results: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 °C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization., Conclusion: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney is a reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient., (Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.)

Bariatric surgery is a treatment that guarantees a substantial and lasting weight loss in addition to the tangible benefits relating to obesity-associated medical conditions. The increasing number of bariatric surgeries has revealed an increasing number of complications related to this procedure, including Wernicke´s encephalopathy and vitamin B deficiency polyneuropathies. Herein, a 7-week post-surgery case of Wernicke´s encephalopathy is presented that emphasizes the importance of an early recognition of these symptoms so as to initiate intervention during the reversible phase of these potentially lethal pathologies.

Background: premature rupture of membranes occurs between 5 and 15% of pregnancies, of these, 10% occurs at term and preterm 2 to 3.5%., Objective: To compare maternal and perinatal outcomes from the use of erythromycin or clindamycin in women with preterm premature rupture of membranes with conservative treatment at the Regional General Hospital No. 36., Patients and Methods: comparative, prospective, randomized study conducted at the Regional General Hospital No. 36 of the Instituto Mexicano del Seguro Social, Puebla. The most common risk factors were cervical infections (55%) and urinary tract infection (55%). A history of premature rupture of membranes in pregnancy was reported in 12.5% of patients. Group A was prescribed erythromycin and group B, standard-dose clindamycin, these were the independent variables. Maternal outcomes (deciduoendometritis and chorioamnionitis) and perinatal (respiratory distress syndrome, necrotizing enterocolitis and sepsis) were the dependent variables. Fisher exact test was applied to the results of the study., Results: about perinatal outcome, sepsis was expressed more frequently in the clindamycin group (60%) compared with erythromycin (35%). The occurrence of respiratory distress syndrome was similar in both groups, 70 and 75% respectively. For necrotizing enterocolitis, 25 and 5%. Maternal alterations as chorioamnionitis occurred in 20% of patients in group A and 5% in group B. Endometritis results were similar in both groups., Conclusions: comparing the maternal and perinatal outcomes with conservative management of premature rupture of membranes, results were better in the group treated with erythromycin. It is not possible to prove it statistically because of the sample size.