Results obtained over the past decade towards the preparation of multitopic carbohydrate architectures combining the molecular inclusion capabilities of cyclomaltooligosaccharide receptors (cyclodextrins, CDs) and the recognition properties of saccharide ligands towards biological receptors are discussed. The potential of these new sugar‐based “intelligent” transporters for site specific delivery of therapeutics is outlined.

a abstract BACKGROUND AND OBJECTIVES: Bronchiolitis, the most common reason for hospitalization in children younger than 1 year in the United States, has no proven therapies effective beyond supportive care. We aimed to investigate the effect of nebulized 3% hypertonic saline (HS) compared with nebulized normal saline (NS) on length of stay (LOS) in infants hospitalized with bronchiolitis. METHODS:We conducted a prospective, randomized, double-blind, controlled trial in an urban tertiary care children's hospital in 227 infants younger than 12 months old admitted with a diagnosis of bronchiolitis (190 completed the study); 113 infants were randomized to HS (93 completed the study), and 114 to NS (97 completed the study). Subjects received 4 mL nebulized 3% HS or 4 mL 0.9% NS every 4 hours from enrollment until hospital discharge. The primary outcome was median LOS. Secondary outcomes were total adverse events, subdivided as clinical worsening and readmissions.RESULTS: Patient characteristics were similar in groups. In intention-to-treat analysis, median LOS (interquartile range) of HS and NS groups was 2.1 (1.2-4.6) vs 2.1 days (1.2-3.8), respectively, P = .73. We confirmed findings with per-protocol analysis, HS and NS groups with 2.0 (1.3-3.3) and 2.0 days (1.2-3.0), respectively, P = .96. Seven-day readmission rate for HS and NS groups were 4.3% and 3.1%, respectively, P = .77. Clinical worsening events were similar between groups (9% vs 8%, P = .97).CONCLUSIONS: Among infants admitted to the hospital with bronchiolitis, treatment with nebulized 3% HS compared with NS had no difference in LOS or 7-day readmission rates.WHAT'S KNOWN ON THIS SUBJECT: Bronchiolitis, the most frequent reason for hospitalization for infants younger than 1 year of age, has no proven treatments beyond supportive care. Although early studies suggested a potential benefit from 3% hypertonic saline, more recent studies have conflicting results. WHAT THIS STUDY ADDS:This prospective, randomized, double-blind, controlled trial in infants admitted with bronchiolitis (including patients with a history of previous wheeze) demonstrated no difference in length of stay between those who received hypertonic saline or normal saline without bronchodilators.

Urinary tract infection (UTI), when left undiagnosed, can lead to renal damage and dysfunction. Understanding how to diagnose, manage, and follow up a UTI is crucial to preventing such consequences.UTI may be classified as cystitis/ pyelonephritis, first/recurrent infection, or complicated/uncomplicated infection. Infections are considered complicated with the following factors: functional or anatomic abnormality of the urinary tract, an indwelling urinary catheter, recent urinary tract instru-mentation, male sex, pregnancy, recent antibiotic use, or immunosuppression. Although the focus of this In Brief is on uncomplicated cystitis, it is important to understand the risk factors for recurrence and complications when evaluating a child who has cystitis for the first time. In teenagers, uncomplicated cystitis is associated most commonly with sexual activity, and counseling is imperative to prevent future infections.Although the overall prevalence of UTI in febrile infants is approximately 5%, certain children are more at risk than others. Risk factors for UTI in a young child include sex (girls Ͼ boys), age (boys Ͻ1 years of age, girls Ͻ5 years of age), race (white Ͼ African American), circumcision (infant boys not circumcised Ͼ those circumcised), first-degree relative who has a history of recurrent UTIs, recent antibiotic use, catheterization, immunocompromise (renal transplantation, acquired immune deficiency syndrome, diabetes mellitus), constipation, voiding dysfunction, vesicoureteral reflux (VUR), neurogenic bladder, and urinary tract obstruction. For adolescents, the use of barrier contraception with spermicide increases the risk for UTI. Among infants, human milk is protective.In all age groups, the most common pathogen causing cystitis is Escherichia coli. In neonates, group B streptococci are a particular concern. Immunocompromised hosts are at risk for infection with less typical agents, such as Enterococcus, BK virus, Pseudomonas aeruginosa, and Candida albicans. Adolescent girls commonly have Staphylococcus saprophyticus infection. Many other agents have been associated with cystitis, including a wide range of gram-negative rods and cocci, grampositive cocci, adenovirus, and both Chlamydia trachomatis and Ureaplasma urealyticum. Lactobacillus, coagulasenegative staphylococci, and Corynebacterium are typical normal flora in children.Children who have cystitis often do not present with the characteristic signs and symptoms seen in adults. The history of a child who has fever should include documentation of the risk factors described previously to evaluate for UTI. Infants younger than 60 to 90 days of age may have vague and nonspecific symptoms, such as failure to thrive, diarrhea, vomiting, irritability, lethargy, malodorous urine, jaundice, and fever. In children younger than 5 years of age, fever and gastrointestinal symptoms are most common. The classic lower urinary tract symptoms of dysuria, urgency, frequency, incontinence, and suprapubic abdominal pain are more common after 5 years of age. The ...

Despite recommendations against routine imaging, chest radiography (CXR) is frequently performed on infants hospitalized for bronchiolitis. We conducted a review of 811 infants hospitalized for bronchiolitis to identify clinical factors associated with imaging findings. CXR was performed on 553 (68%) infants either on presentation or during hospitalization; 466 readings (84%) were normal or consistent with viral illness. Clinical factors significantly associated with normal/viral imaging were normal temperature (odds ratio = 1.66; 95% CI = 1.03-2.67) and normal oxygen saturation (odds ratio = 1.77; 95% CI = 1.1-2.83) on presentation. Afebrile patients with normal oxygen saturations were nearly 3 times as likely to have a normal/viral CXR as patients with both fever and hypoxia. Our findings support the limited role of radiography in the evaluation of hospitalized infants with bronchiolitis, especially patients without fever or hypoxia.