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Matti Uhari

Publications and source records attributed to Matti Uhari.

At least 19 recordsLinked to original sources
PubMed2006

Meta-analysis of vesicoureteral reflux and urinary tract infection in children.

OBJECTIVE: We evaluated the efficacy of medical and surgical treatment of vesicoureteral reflux (VUR) in children by means of a meta-analysis, using the recurrence of urinary tract infections (UTIs), renal growth and renal scarring as endpoints. MATERIAL AND METHODS: We performed a MEDLINE search for articles published in the English language between 1966 and 2002. Of 639 relevant articles found, 139 were chosen for a close review and the main database was supplemented with some additional articles derived from the references of these reviewed articles. Five studies were found acceptable for a meta-analysis. We reviewed all articles independently. All reviewers had to approve the accepted articles and data that were used in this meta-analysis. RESULTS: Operative treatment of VUR was better than medical treatment in terms of abolishing reflux (OR = 0.033; 95% CI 0.010-0.107). We found no statistically significant differences between surgically and medically treated patients in terms of kidney growth (OR = 2.46; 95% CI 0.74-8.16), scarring (OR = 1.05; 95% CI 0.71-1.55) or recurrence of UTIs (OR = 0.80; 95% CI 0.49-1.29). We could not evaluate possible differences in the parameters monitored between boys and girls because of a lack of data. CONCLUSIONS: Although surgical treatment of VUR is a common pediatric urologic procedure, the data relating to it are scanty. We found no clinically significant differences between surgical and medical treatment for VUR other than in the resolution of VUR itself. On the basis of present evidence we suggest that a child with UTI and significant VUR should be treated conservatively at first and that surgical treatment should be reserved for children who experience problems with antimicrobials or persistent clinically significant VUR after several years of follow-up.

Child↗
PubMed2006

Disappearance of middle ear effusion in acute otitis media monitored daily with tympanometry.

BACKGROUND: Disappearance of middle ear effusion is one of the most important outcomes in the treatment of acute otitis media (AOM). AIM: To evaluate the duration of effusion in AOM treated by antimicrobials and to find factors influencing it. METHODS: Parents of 90 children with AOM monitored daily the disappearance of effusion with tympanometry. The children were randomly allocated to be treated with either oral amoxicillin or cefuroxime-axetil for 10 d. Daily monitoring lasted for 14 d or until the tympanogram was normal (curve A or C) in both ears. Pneumatic otoscopy was carried out every 2 wk. RESULTS: Normal tympanograms were obtained after a median time of 7.5 d (range 1-58 d) among 75 successfully monitored patients. In two-thirds (69%) of them, effusion resolved in 14 d. The median duration of effusion did not differ significantly between the two treatment groups (8 vs 7 days, p=0.7). The children who had unilateral AOM cured more rapidly than those with bilateral AOM (5 vs 19 d, p<0.001). In logistic regression analysis adjusted for age, bilaterality explained treatment failure at 2 wk with an odds ratio of 28.1 (95% CI 4.6-169.5, p<0.001). CONCLUSION: The choice of antimicrobials did not influence the duration of middle ear effusion, which was much shorter than had been thought previously. Children with unilateral AOM were cured much more quickly than those with bilateral AOM.

Acoustic Impedance Tests↗
PubMed2006

Nasal middle meatal specimen bacteriology as a predictor of the course of acute respiratory infection in children.

AIMS: To test our hypothesis that children with potentially pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis) in the nasal middle meatus might have more prolonged symptoms of acute respiratory infection than children without such bacteria, we conducted a prospective cohort study of such children. MATERIALS AND METHODS: We recruited prospectively child volunteers between 6 and 13 years of age with acute respiratory infections present for fewer than 10 days. Nasal middle meatal bacterial culture was taken with a rigid endoscope at enrollment and again after 3 weeks and evaluated for presence or absence of 3 potential pathogens: S. pneumoniae, H. influenzae and M. catarrhalis. The subsequent persistence of acute symptoms (nasal discharge: clear/colored, nasal obstruction and cough) was determined by means of a diary. Viral etiology was studied with polymerase chain reaction methods. RESULTS: The 82 children had had symptoms for an average of 4 days (range, 1-10) at entry, and viruses were detected in 54% (39 of 72). The endoscopic procedure and bacteriologic sampling succeeded in all cases. Thirty-eight children (46%) had at least 1 of the 3 pathogens in the middle meatus specimen. The children with nasal pathogens present at entry had a significantly longer mean duration of symptoms than those with nonpathogenic bacteria (difference, 3.6 days; 95% confidence interval, 0.7-6.5; P = 0.025). The effect remained significant after adjustment for age, sex, allergic symptoms and the presence of virus (adjusted relative hazard of delayed recovery, 2.0; 95% confidence interval, 1.1-3.6). CONCLUSIONS: We found that the use of endoscopic swab culture sampling from the nasal middle meatus is well-tolerated by children older than 6 years of age and that it can be useful in selected situations to determine pathogenic bacteria in the culture of these specimens.

Acute Disease↗
PubMed2006

Dynamics of gut colonization and source of intestinal flora in healthy newborn infants.

The aim of the study was to evaluate the dynamics of gut colonization and the main source of intestinal bacterial flora in infancy in a quantitative manner using computerized analysis of bacterial cellular fatty acid (CFA) profiles. Each stool was collected from 10 healthy newborn infants during their first 2-7 days of life and a follow-up sample at 6 months of age. Stool samples were collected from mothers and nurses for comparison. Gas-liquid chromatography of the 159 stool samples was used to produce bacterial cellular fatty acid (CFA) profiles by means of a previously developed computerized program. The CFA profiles for the infants fluctuated from hour to hour during the first days of life and resembled those for both the mothers and the nurses, doing so all the more in the case of the five infants examined 6 months after birth. Gut colonization fluctuated markedly from hour to hour in the perinatal period. The effect of the maternal flora on the initial gut colonization may be less than expected as the fecal flora of infants started to resemble both the fecal flora of the mother as well as that of the first nurse.

Birth Weight↗
PubMed2005

Cranberry juice and bacterial colonization in children--a placebo-controlled randomized trial.

BACKGROUND: The cranberry produces antimicrobial compounds such as proanthocyanidines in response to microbial invasion. In vitro it is able to prevent growth, adhesion or biofilm formation of a large number of bacteria, while clinically, cranberry juice has been shown to prevent urinary tract infections (UTI) in women. However, the effect of cranberry on bacterial colonization more widely has not been evaluated. We were interested in studying cranberry juice in children since many children with recurrent UTI need long-term antimicrobial prophylaxis and would benefit from an alternative. OBJECTIVE: To evaluate the effect of cranberry juice on nasopharyngeal and colonic bacterial flora, to evaluate how well cranberry juice is accepted by children and to evaluate its effect on infectious diseases and related symptoms. DESIGN: Children (mean age 4.3 years) in day care centers were randomized to receive either cranberry juice (n=171) or a placebo (n=170) for 3 months. Bacterial samples were collected before and after the intervention and analyzed for both respiratory bacterial pathogens and enteric fatty acid composition, reflecting changes in the colonic bacterial flora. Infectious diseases and their symptoms were monitored using symptom diaries. Compliance was evaluated as the number of drop-outs during the trial and by counting the numbers of doses taken. RESULTS: The carriage of respiratory bacteria did not change significantly during the intervention, while fecal fatty acid composition changed significantly with time (P<0.001) but did not differ between the groups (P>0.05). Cranberry juice had no effect on common infectious diseases or their symptoms. The cranberry juice was well accepted: the number of drop-outs in 3 months was 18 (11%) in the cranberry group and 11 (7%) in the placebo group, and most of the doses were taken as instructed, 145 (88%) and 129 (77%) children, respectively, taking at least 90% of the doses. CONCLUSIONS: Cranberry juice was well accepted by the children, but led to no change in either the bacterial flora in the nasopharynx or the bacterial fatty acid composition of stools. Thus cranberries seem to have beneficial effect on urinary health only and this is not compromised by other unexpected antimicrobial effects.

Beverages↗
PubMed2005

Cefuroxime axetil versus placebo for children with acute respiratory infection and imaging evidence of sinusitis: a randomized, controlled trial.

AIM: To evaluate the efficacy of antibiotic treatment in children who presented in medical care with respiratory infection and had imaging evidence of sinusitis. METHODS: Eighty-two children (4-10 y) with acute respiratory symptoms and ultrasonography findings suggestive of acute rhinosinusitis were enrolled in a randomized, double-blind trial. The sinus findings were confirmed with plain radiographs. The children received either cefuroxime axetil in 125-mg capsules twice a day for 10 d or placebo. Main outcome measures were complete cure in 2 wk and absence of prolonged symptoms or complications. RESULTS: A total of 72 children (88%) completed follow-up. The sinusitis findings in the ultrasound could be confirmed with plain radiographs in 65 of the 72 patients (90%). The proportion of children completely cured by day 14 was similar in both groups (difference 6%, 95% confidence interval -16% to 29%). Similarly, there was no significant difference in the proportions of children who escaped prolonged disease and complications between the groups (difference 7%, -9% to 24%). CONCLUSION: A 10-d course of cefuroxime axetil offered no clinical benefit to children with an acute respiratory illness and imaging evidence of acute sinusitis.

Acute Disease↗
PubMed2004

Ultrastructure of Streptococcus pneumoniae after exposure to xylitol.

OBJECTIVES: Xylitol is a sugar alcohol which reduces the growth of Streptococcus pneumoniae and the adherence of pneumococci and Haemophilus influenzae to nasopharyngeal cells. Xylitol prevents acute otitis media but does not decrease nasopharyngeal carriage of pneumococci. We hypothesized that xylitol could affect the surface structures of viable pneumococci, which would further explain the mechanism of action of xylitol in preventing acute otitis media. METHODS: We exposed five strains of pneumococci to 0.5%-5% xylitol, 5% glucose, 5% fructose and 5% sorbitol or control medium (brain heart infusion) for 0.5-2 h and examined the ultrastructure of bacteria by electron microscopy. RESULTS: The cell wall of pneumococci became more diffuse, the polysaccharide capsule became ragged and the proportion of damaged pneumococci increased after exposure to xylitol for 2 h, but not after exposure to other sugars or control medium. The phenotype of all pneumococcal strains was opaque before xylitol exposure and became almost transparent both in xylitol and in control medium during the experiment. CONCLUSIONS: This study demonstrates further that xylitol has a harmful effect on pneumococci. The observed changes in the polysaccharide capsule and the cell wall of pneumococci could affect the adherence and virulence of pneumococci, explaining the good clinical efficacy of xylitol in the prevention of acute otitis media.

Culture Media↗
PubMed2004

Dietary factors affecting susceptibility to urinary tract infection.

Urinary tract infection (UTI) is usually an ascending infection caused by bacteria derived from stools. Since the bacterial composition of stools is dependent on the diet, it is likely that the risk of UTI will change with changes in the diet. Most data describing diet as a risk factor for UTI come from epidemiological and interventional trials. It has been shown in a case-control setting that frequent consumption of fresh berry or fruit juices and fermented milk products containing probiotic bacteria decreases the risk for UTI recurrence in women. Several interventional trials have found Vaccinium berry products to provide protection from UTI recurrence. Probiotics have not been able to prevent UTI in interventional trials. However, the lack of an effect may be related to too low a dose or to the use of non-optimal products in these trials. Limited data are available on the effects of nutrition on UTI in children. However, there is no reason to expect that children would be different from adults in this respect. In this review, we discuss the dietary factors affecting the susceptibility to UTI.

Adult↗
PubMed2004

Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial.

OBJECTIVE: To evaluate the efficacy of adenoidectomy compared with long term chemoprophylaxis and placebo in the prevention of recurrent acute otitis media in children aged between 10 months and 2 years. DESIGN: Randomised, double blind, controlled trial. SETTING: Oulu University Hospital, a tertiary centre in Finland. PARTICIPANTS: 180 children aged 10 months to 2 years with recurrent acute otitis media. INTERVENTION: Adenoidectomy, sulfafurazole (sulphisoxazole) 50 mg/kg body weight, given once a day for six months or placebo. Follow up lasted for two years, during which time all symptoms and episodes of acute otitis media were recorded. MAIN OUTCOME MEASURES: Intervention failure (two episodes in two months or three in six months or persistent effusion) during follow up, number of episodes of acute otitis media, number of visits to a doctor because of any infection, and antibiotic prescriptions Number of prescriptions, and days with symptoms of respiratory infection. RESULTS: Compared with placebo, interventions failed during both the first six months and the rest of the follow up period of 24 months similarly in the adenoidectomy and chemoprophylaxis groups (at six months the differences in risk were 10% (95% confidence interval -9% to 29%) and 18% (-2% to 38%), respectively). No significant differences were observed between the groups in the numbers of episodes of acute otitis media, visits to a doctor, antibiotic prescriptions, and days with symptoms of respiratory infection. CONCLUSIONS: Adenoidectomy, as the first surgical treatment of children aged 10 to 24 months with recurrent acute otitis media, is not effective in preventing further episodes. It cannot be recommended as the primary method of prophylaxis.

Adenoidectomy↗
PubMed2004

Human leukocyte antigens B8-DRB1*03 in pediatric patients with nephropathia epidemica caused by Puumala hantavirus.

In adults, HLA haplotype B8-DRB1*03 is clearly associated with a severe clinical course of nephropathia epidemica caused by Puumala hantavirus. We investigated whether the same applies in pediatric patients. This HLA haplotype was found in 20 of 39 (51%) of the patients, a significantly higher figure than in the Finnish population (19%). There were, however, no significant differences in the clinical picture between patients with and without HLA B8-DRB1*03.

Adolescent↗
PubMed2003

Experiences of using an interactive audience response system in lectures.

BACKGROUND: Lectures are good for presenting information and providing explanations, but because they lack active participation they have been neglected. METHODS: Students' experiences were evaluated after exposing them to the use of voting during lectures in their paediatrics course. Questions were delivered to the students taking paediatrics course. Thirty-six students out of the total of 40 (90%) attended the opening lecture, at which the first survey concerning previous experiences of lectures was performed. Thirty-nine students (98%) answered the second series of questions at the end of the paediatrics course. RESULTS: Most of the students felt that voting improved their activity during lectures, enhanced their learning, and that it was easier to make questions during lectures than earlier. CONCLUSIONS: The students gained new, exciting insights much more often during the paediatrics course than before. We as teachers found that voting during lectures could easily overcome some of the obstacles of good lecturing.

Education, Medical↗
PubMed2003

Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study.

CONTEXT: Exposure to cardiovascular risk factors during childhood and adolescence may be associated with the development of atherosclerosis later in life. OBJECTIVE: To study the relationship between cardiovascular risk factors measured in childhood and adolescence and common carotid artery intima-media thickness (IMT), a marker of preclinical atherosclerosis, measured in adulthood. DESIGN, SETTING, AND PARTICIPANTS: Population-based, prospective cohort study conducted at 5 centers in Finland among 2229 white adults aged 24 to 39 years who were examined in childhood and adolescence at ages 3 to 18 years in 1980 and reexamined 21 years later, between September 2001 and January 2002. MAIN OUTCOME MEASURES: Association between cardiovascular risk variables (levels of low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides; LDL-C/HDL-C ratio; systolic and diastolic blood pressure; body mass index; smoking) measured in childhood and adulthood and common carotid artery IMT measured in adulthood. RESULTS: In multivariable models adjusted for age and sex, IMT in adulthood was significantly associated with childhood LDL-C levels (P =.001), systolic blood pressure (P<.001), body mass index (P =.007), and smoking (P =.02), and with adult systolic blood pressure (P<.001), body mass index (P<.001), and smoking (P =.004). The number of risk factors measured in 12- to 18-year-old adolescents, including high levels (ie, extreme age- and sex-specific 80th percentile) of LDL-C, systolic blood pressure, body mass index, and cigarette smoking, were directly related to carotid IMT measured in young adults at ages 33 through 39 years (P<.001 for both men and women), and remained significant after adjustment for contemporaneous risk variables. The number of risk factors measured at ages 3 to 9 years demonstrated a weak direct relationship with carotid IMT at ages 24 to 30 years in men (P =.02) but not in women (P =.63). CONCLUSIONS: Risk factor profile assessed in 12- to 18-year-old adolescents predicts adult common carotid artery IMT independently of contemporaneous risk factors. These findings suggest that exposure to cardiovascular risk factors early in life may induce changes in arteries that contribute to the development of atherosclerosis.

Adolescent↗