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Background Accurate tools to distinguish Crohn's disease [CD] from cryptoglandular disease in patients with perianal fistulas without detectable luminal inflammation on ileocolonoscopy and abdominal enterography (isolated perianal fistulas [IPF]) are lacking. We assessed the ability of video capsule endoscopy [VCE] to detect luminal inflammation in patients with IPF. Methods We studied consecutive adults [>17 years] with IPF who were evaluated by VCE after a negative ileocolonoscopy and abdominal enterography between 2013 and 2022. We defined luminal CD by VCE as diffuse erythema, three or more aphthous ulcers, or a Lewis score greater than 135. We compared rates of intestinal inflammation in this cohort with age- and sex-matched controls without perianal fistulas, who underwent VCE for other indications. We excluded persons with pre-existing inflammatory bowel disease [IBD] and exposure to non-steroidal anti-inflammatory drugs or immunosuppressive treatments. Results A total of 45 patients with IPF underwent VCE without complications. Twelve patients [26%] met our definition of luminal CD. Luminal CD was more common in patients with IPF than in controls [26% vs 3%; p  <0.01]. Among patients with IPF, male sex (OR [odds ratio], 9.2; 95% confidence interval [CI] [1.1-79.4]), smoking (OR, 4.5; 95% CI [0.9-21.2]), abscess (OR, 6.3; 95% CI [1.5-26.8]), rectal enhancement on magnetic resonance imaging [MRI] (OR, 9.0; 95% CI [0.8-99.3]), and positive antimicrobial serology (OR, 7.1; 95% CI, [0.7-70.0]) were more common in those with a positive VCE study. Conclusions VCE detected small intestinal inflammation suggestive of luminal CD in approximately one-quarter of patients with IPF. Larger studies are required to validate these findings. [ABSTRACT FROM AUTHOR]

Crown policies and private enterprise combined to increase efficiency levels in Portuguese overseas expansion. Within this framework, this paper will emphasize three themes. Firstly, the dependence of the Portuguese empire on shipping efficiency; while the debate largely focuses on shipbuilding and seafarers, we show how crown policies and individual enterprises adapted to the evolving requirements of an empire based on sea power. Secondly, we demonstrate how informal and self-organized mechanisms at times contributed to, and sometimes blocked, state-oriented policies. Thirdly, we gauge the extent to which local inputs, such as raw materials, labour and techniques, contributed to efficiency levels within a universe that became multi-continental. [ABSTRACT FROM AUTHOR]

Shipbuilding was an essential element in the creation of overseas empires during the early modern period. It generated demand for raw materials, technology and manpower, and in many cases received direct support from the state. The Portuguese shipbuilding industry enjoyed various incentives from the Crown, but was always a mix between state and private enterprise. With Portugal expanding overseas, building and repairing ships in the various Portuguese possessions became an option. Initially, it was viewed critically by the metropolitan authorities, as they feared losing control. Soon, however, the logistical needs of empire meant that public and private agencies began providing shipbuilding facilities in Portugal's overseas territories. In Brazil, the abundance of high-quality wood militated in favour of the establishment of shipyards. Wood cut there or on the Atlantic coast of Africa was also transported to metropolitan Portugal. Shipbuilding specialists were sent out to Brazil to supervise the selection of suitable wood, and soon started to operate shipyards there. Little is known about shipbuilding in the Portuguese possessions in western Africa, while more can be said about the industry on the shores of the Indian Ocean. Shipyards in India, particularly in Goa and Cochin, were developed to meet the challenges and needs of formal and informal 'empire', particularly regarding ship repairs. The Ribeira de Goa replicated first the Ribeira das Naus of Lisbon, but soon individual shipyards took over specific functions. Crown control, initially tight and systematic, proved difficult to maintain. Indian woods were known for their hardness and durability and were shipped to Europe to build ships for the Indian Route. Expert labourers migrated from Portugal to overseas possessions, with specialists in metallurgy joining the shipbuilders. The scope of the operation also required the recruitment of local shipbuilders. In general, and for its financial resources, Portuguese colonial shipbuilding soon relied on a cooperation of state and private initiative, much as at home. [ABSTRACT FROM AUTHOR]

Purpose Some parents blame their children for bedwetting and, therefore, punish them. This study aimed to assess the rate of punishment experienced by enuretic children and associated causative factors. Materials and Methods A total of 87 children 6 to 15 years old with monosymptomatic enuresis were assessed individually. Parents answered the questions in the tolerance scale. The forms of punishment were classified as verbal, chastisement and physical aggression. Family history of enuresis was considered only when 1 or both parents had experienced enuresis. Results Of the 35 girls and 52 boys with a mean ± SD age of 9.3 ± 2.3 years 67 had a family history of enuresis. Of the 67 parents 57 (85.0%) had a history of being punished due to enuresis. All children experienced some sort of verbal punishment. Children who had a family history of enuresis were more prone to being punished by physical aggression than those without such a family history (32 of 67 or 47.8% vs 4 of 20 or 20%, OR 3.7, 95% CI 1.1–12.1, p = 0.03). Punishment was found 3 times more frequently in girls than in boys (20 of 35 or 57.1% vs 16 of 52 or 30.8%, OR 3.0, 95% CI 1.2–7.3). Parents of 79 of the 87 children (90.8%) had high scores on the tolerance scale regardless of the history of enuresis. Conclusions Enuretic children are at a high risk for experiencing some kind of punishment. Children whose parents had enuresis are at risk for being physically punished. Parents should be taught about the involuntary nature of enuresis and the fact that no punishment would help improve the condition. [ABSTRACT FROM AUTHOR]

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Purpose We determined the effectiveness of 2 methods to treat overactive bladder in children using intragroup and intergroup comparisons in a randomized clinical trial. Materials and Methods Nine boys and 19 girls with a mean ± SD age of 6.4 ± 2.18 years were randomly divided into group 1—parasacral transcutaneous electrical stimulation with placebo drug and group 2—oxybutynin with sham scapular electrical therapy. Success was assessed by 1) the rate of complete symptom resolution, 2) a visual analog scale of 0 to 10, 3) the dysfunctional voiding score system, 4) voiding diary records, 5) Rome III criteria and 6) side effect frequency in each group. Results A total of 13 and 15 patients were randomized to groups 1 and 2, respectively. Symptoms completely resolved in 6 patients in group 1 (46%) and 3 in group 2 (20%) (p = 0.204). A statistically significant improvement was found in the 2 groups in the dysfunctional voiding score system and voiding diary records. However, no statistically significant difference was found between the groups in the visual analog scale score, voiding frequency, and maximum and mean voided volume (p = 0.295, 0.098, 0.538 and 0.650, respectively). Constipation improved in 100% of group 1 patients but in only 55% in group 2 (p = 0.031 vs 0.073). Group 1 showed no side effects while dry mouth, hyperthermia and hyperemia developed in 58%, 25% and 50% of group 2 patients (p = 0.002, 0.096 and 0.005, respectively). Treatment was discontinued by 13.3% of patients in group 2. Conclusions Parasacral transcutaneous electrical stimulation was as effective as oxybutynin to treat overactive bladder in children. However, transcutaneous parasacral electrical stimulation was more effective against constipation and showed no detectable side effects. Oxybutynin was more effective for decreasing voiding frequency. [ABSTRACT FROM AUTHOR]

Purpose: Parasacral transcutaneous electrical neural stimulation is widely used to treat hyperactive bladder in children and adults. Its use in nonmonosymptomatic enuresis has demonstrated improvement in number of dry nights. We assessed the effectiveness of parasacral transcutaneous electrical neural stimulation in the treatment of monosymptomatic primary enuresis. Materials and Methods: This prospective randomized clinical trial included 29 girls and 16 boys older than 6 years with primary monosymptomatic enuresis. Children were randomly divided into 2 groups consisting of controls, who were treated with behavioral therapy, and an experimental group, who were treated with behavioral therapy plus 10 sessions of parasacral transcutaneous electrical neural stimulation. Neural stimulation was performed with the electrodes placed in the sacral region (S2/S3). Sessions always followed the same pattern, with duration of 20 minutes, frequency of 10 Hz, a generated pulse of 700 μs and intensity determined by the sensitivity threshold of the child. Sessions were done 3 times weekly on alternate days. Patients in both groups were followed at 2-week intervals for the first month and then monthly for 6 consecutive months. Results: Rate of wet nights was 77% in controls and 78.3% in the experimental group at onset of treatment (p = 0.82), and 49.5% and 31.2%, respectively, at the end of treatment (p = 0.02). Analyzing the average rate of improvement, there was a significantly greater increase in dry nights in the group undergoing neural stimulation (61.8%) compared to controls (37.3%, p = 0.0038). At the end of treatment percent improvement in children undergoing electrical stimulation had no relation to gender (p = 0.391) or age (p = 0.911). Conclusions: Treatment of primary monosymptomatic enuresis with 10 sessions of parasacral transcutaneous electrical neural stimulation plus behavioral therapy proved to be effective. However, no patient had complete resolution of symptoms. [Copyright &y& Elsevier]

Summary Introduction Overactive bladder (OAB) is the most prevalent voiding disorder in childhood, and its main manifestation is urinary urgency. In general, urotherapy and anticholinergics are the first choices of treatment. Parasacral Transcutaneous Electrical Neural Stimulation (PTENS) was introduced as an alternative for the treatment of detrusor overactivity in children, but treatment protocols described to date require several sessions per week or long-lasting sessions, making it difficult for the child to adhere to the treatment. Thus, this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children. Study design This prospective, randomized controlled trial included 16 children with OAB. Children were divided into two groups: CG (urotherapy and electrical stimulation placebo) and EG (urotherapy and PTENS). For both groups, therapy was delivered in 20 weekly sessions, of duration 20 min each. Placebo electrical stimulation was done in the scapular area. The children were evaluated prior to treatment (T1), at the end of the 20 sessions (T2), and 60 days after the completion of treatment (T3), with a 3-day voiding diary, visual analogue scale (VAS), Rome III diagnostic criteria, and the Bristol Scale. Results The groups were similar in age, gender, and ethnicity. In the initial assessment, all children, in both groups, had urgency and incontinence, 50% in each group had constipation, and enuresis was present in seven children (87.5%) in the EG and six (75%) in the CG. No differences were found between the groups regarding the volumetric measurements made in the voiding diary, urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale. Sixty days after treatment, a significant improvement was found in the EG group ( p = 0.03) regarding urgency (Table), as well as an increase in dry nights in those presenting with enuresis ( p = 0.03). No difference was noted regarding urinary incontinence (Table). At the end of 20 sessions and after 60 days of treatment, those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS ( p = 0.05 and 0.04, respectively). Conclusions Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis, and in the perception of those responsible for the children. Further studies with larger populations are needed to corroborate these results. Table Urgency and urinary incontinence after treatment. Table EG, n (%) CG, n (%) p Urgency T1 Yes 8 (100.00) 8 (100.00) 1.00 No 0 (0) 0 (0) T2 Yes 3 (42.86) 6 (85.71) 0.26 No 4 (57.14) 1 (14.29) T3 Yes 2 (28.57) 6 (85.71) 0.03 No 5 (71.43) 1 (14.29) Urinary incontinence T1 Yes 8 (100.00) 8 (100.00) 1.00 No 0 (0) 0 (0) T2 Yes 2 (28.57) 5 (71.43) 0.28 No 5 (71.43) 2 (28.57) T3 Yes 2 (28.57) 5 (71.43) 0.28 No 5 (71.43) 2 (28.57) [ABSTRACT FROM AUTHOR]

Summary Introduction Although the relationship between enuresis and breastfeeding is still poorly documented in the literature, a possible association is speculated as both are strongly associated with children's development. Therefore, the main objective of this study was to evaluate whether there is an association between primary enuresis and the duration of exclusive breastfeeding. Material and methods This is an observational, case-control study, involving 200 children and adolescents from 6 to 14 years old, who were divided into two groups: the enuresis group (EG), composed of 100 children with primary enuresis; and the control group (CG) of 100 matched children without enuresis. The matching criteria were sex, age, and socioeconomic level. Adults responsible for each infant answered a structured questionnaire to identify biological and behavioral factor, as well as the duration of maternal breastfeeding. Children whose parents could not comprehend the questionnaire or children with neurological or psychiatric disorders or secondary enuresis were not included in the study. Results and discussion Evaluating the duration of exclusive breastfeeding, 72% of the subjects of the EG and 42% of the CG had been breastfed for less than 4 months ( p < 0.001) (Figure). In bivariate analysis, there was a strong association between symptoms of enuresis with a positive family history of enuresis and duration of exclusive breastfeeding ( p < 0.001), and also association with full breastfeeding duration ( p = 0.044), number of children ( p = 0.045), and parents' education ( p = 0.045). After logistic regression, primary enuresis continued to be associated with duration of exclusive breastfeeding and family history of enuresis. The proportion of children that had been exclusively breastfed for more than 4 months was significantly higher in the CG 58% (58/100) than in the EG 28% (28/100) ( p < 0.001, OR 4.35, 95% CI 1.99–9.50). Conclusions This study confirmed the association between primary enuresis and various factors that have already been studied, with the addition of a new factor, duration of exclusive breastfeeding for less than 4 months, which is strongly associated with primary enuresis. Figure Time of exclusive breastfeeding in enuresis and control groups. [ABSTRACT FROM AUTHOR]