No abstract

No abstract

Background Pop-off mechanisms are potential pressure-relieving mediators in patients diagnosed with posterior urethral valves (PUV). These mechanisms include, among others, urachal persistence, urinomas, bladder diverticula and unilateral high-grade vesicoureteral reflux. The aim of this systematic review was to synthesize the existing evidence regarding the protective effect of pop-off mechanisms on renal function in children with PUV. Methods We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography. Three independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion criteria. Methodological quality of the selected article was rated using the Newcastle Ottawa Scale index. Data extraction was performed by three independent reviewers. We used random meta-analyses to compare different outcomes (serum creatine, Nadir serum creatinine, and renal failure) between children with PUV and pop-off mechanisms and those with PUV but without pop-off mechanisms. Results 10 studies with data from 896 participants were included in this review. The age of the participants ranged from 0 to 25 years. Seven articles reported serum creatinine values for each group and 3 of them found significant differences between groups. The random-effects meta-analysis for serum creatinine showed significant lower mean (diff=-52.88 µmol/L [95% CI -73.65 to -32.11]) in the group of children with pop-off mechanisms, and the random-effects meta-analysis for Nadir serum creatinine showed a marginally significant lower mean in the group of children with pop-off mechanisms (diff=-12.00 µmol/L [95% CI -24.04 to 0.04]). The random-effect meta-analysis for renal failure resulted in a significant risk reduction on the group of children with pop-off mechanisms (odds ratio = 0.48 [95% CI 0.23 to 0.98]). Conclusions Children with PUV and pop-off mechanisms show better renal function and lower risk of renal failure than those with PUV but without pop-off mechanisms suggesting these mechanisms may act as renoprotective mediums. The high heterogeneity between studies in the assessment of renal function and long-term outcomes compel to interpret these findings with caution. Future studies that stratify by the different types of pop-off mechanisms and use standardized metrics, such as Nadir creatinine are needed.

to have a benign course, but they can sometimes be invasive and cause local recurrences. Metastasization has also been described in relation to these tumors [4]. Clinically, the presentation is highly variable, including asymptomatic cases. The presence of prolonged fever, thrombocytosis, and elevated serum inflammatory markers are common findings in IMT. The case presented here corresponds to a mesoileal IMT, being one of the few reported to date in the scientific literature. Similarly, the early age of presentation, at 2 mo of age, is exceptional. Given its infrequency, long-term followup of intestinal IMT is scarcely reported in the literature. DeclarationsInformed Consent Verbal and written informed consent was obtained from the patient's parents prior to the submission of this manuscript.

The aim of this study was to analyze the diagnostic performance of Leucine-Rich Alpha-2-Glycoprotein (LRG1) in pediatric acute appendicitis (PAA). We conducted a systematic review of the literature in the main databases of medical bibliography. Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS2 index. A synthesis of the results, standardization of the metrics and 4 random-effect meta-analyses were performed. Eight studies with data from 712 participants (305 patients with confirmed diagnosis of PAA and 407 controls) were included in this review. The random-effect meta-analysis of serum LRG1 (PAA vs control) resulted in a significant mean difference (95% CI) of 46.76 μg/mL (29.26–64.26). The random-effect meta-analysis for unadjusted urinary LRG1 (PAA vs control) resulted in a significant mean difference (95% CI) of 0.61 μg/mL (0.30–0.93). The random-effect meta-analysis (PAA vs control) for urinary LRG1 adjusted for urinary creatinine resulted in a significant mean difference (95% CI) of 0.89 g/mol (0.11–1.66).   Conlusion: Urinary LRG1 emerges as a potential non-invasive biomarker for the diagnosis of PAA. On the other hand, due to the high between-study heterogeneity, the results on serum LRG1 should be interpreted with caution. The only study that analyzed salivary LRG1 showed promising results. Further prospective studies are needed to confirm these findings. What is Known:• Pediatric acute appendicitis continues to be a pathology with a high rate of diagnostic error.• Invasive tests, although useful, are a source of stress for patients and their parents. What is New:• LRG1 emerges as a promising urinary and salivary biomarker for the noninvasive diagnosis of pediatric acute appendicitis.