Do small for gestational age infants have less severe neonatal abstinence syndrome?

BACKGROUND: Small for gestational age (SGA) infants are likely to have decreased placental transfer of opioids and other substances and lower amounts of fat deposition, hence less severe neonatal abstinence syndrome (NAS). The goal of this study is to correlate SGA status and severity of NAS in infants admitted to the neonatal intensive care unit (NICU). METHODS: This is a retrospective analysis of term and late-preterm infants (≥35 weeks gestation) exposed to in-utero substances, born between September 2006 and May 2021, and admitted to an inner-city NICU for medical therapy for NAS. Indicators of the severity of NAS (duration of medical treatment, duration of hospitalization, use of phenobarbital, and use of clonidine) were compared between infants characterized as SGA (birth weight <10th percentile for gestational age) to those not categorized as SGA (non-SGA). RESULTS: A total of 992 infants met the study criteria; 205 (20.7%) in the SGA group and 787 (79.3%) in the non-SGA group. The median duration of medical treatment was significantly lower in infants in the SGA group (22 days vs. 26 days, p = 0.04) and they were less likely to be treated with phenobarbital (19% vs. 26.8%, p = 0.02). CONCLUSION: SGA infants displayed less severe NAS symptoms as indicated by shorter a duration of medical treatment and decreased need for phenobarbital. Our findings may impact decisions around identifying the optimum treatment protocols catered to SGA infants with NAS.

Multiparametric Magnetic Resonance Imaging in Evaluation of Clinically Significant Prostate Cancer.

Aim In this prospective study, we evaluate the role of multiparametric magnetic resonance imaging (mp-MRI) in the assessment of clinically significant prostate cancer at 1.5 T without endorectal coil (ERC). Materials and Methods Forty-five men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] level > 4 ng/mL, hard prostate on digital rectal examination, and suspicious area at transrectal ultrasound [TRUS]) were evaluated using the mp-MRI protocol over a period of 24 months. All cases were interpreted using the Prostate Imaging Reporting and Data System (PI-RADS) version 2 guidelines and correlated with histopathology. Statistical Analysis Used A chi-squared test was used for analysis of nominal/categorical variables and receiver operating characteristic (ROC) curve and one-way analysis of variance (ANOVA) test for continuous variables. Results The mean age was 67 years and the mean PSA was 38.2 ng/mL. Eighty percent had prostate cancer and 20% were benign (11% benign prostatic hyperplasia [BPH] and 9% chronic prostatitis). Eighty-six percent of all malignancies were in the peripheral zone. The PI-RADS score for T2-weighted (T2W) imaging showed good sensitivity (81%) but low specificity (67%). The PI-RADS score for diffusion weighted imaging (DWI) with sensitivity of 92% and specificity of 78% had a better accuracy overall than T2W imaging alone. The mean apparent diffusion coefficient (ADC) value (×10 -6 mm 2 /s) was 732 ± 160 in prostate cancer, 1,009 ± 161 in chronic prostatitis, 1,142 ± 82 in BPH, and 663 in a single case of granulomatous prostatitis. Low ADC values (<936) have shown good correlation (area under curve [AUC]: 0.87) with the presence of cancer foci. Inverse correlation was observed between Gleason scores and ADC values. Dynamic contrast-enhanced (DCE) imaging has shown 100% sensitivity/negative predictive value (NPV), but moderate specificity (67%) in predicting malignancy. The final PI-RADS score had 100% sensitivity and NPV with good overall positive predictive value (PPV) of 95%. Conclusions T2W imaging and DWI remain the mainstays in diagnosis of prostate cancer with mp-MRI. DCE-MRI can be a problem-solving tool in case of equivocal findings. Because assessment with mp-MRI can be subjective, use of the newly developed PI-RADS version 2 scoring system is helpful in accurate interpretation.

Genetic risk score and adiposity interact to influence triglyceride levels in a cohort of Filipino women.

BACKGROUND/OBJECTIVES: Individually, genetic variants only moderately influence cardiometabolic (CM) traits, such as lipid and inflammatory markers. In this study we generated genetic risk scores from a combination of previously reported variants influencing CM traits, and used these scores to explore how adiposity levels could mediate genetic contributions to CM traits. SUBJECTS/METHODS: Participants included 1649 women from the 2005 Cebu Longitudinal Health and Nutrition Survey. Three genetic risk scores were constructed for C-reactive protein (CRP), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs). We used linear regression models to assess the association between each genetic risk score and its related trait. We also tested for interactions between each score and measures of adiposity. RESULTS: Each genetic risk score explained a greater proportion of variance in trait levels than any individual genetic variant. We found an interaction between the TG genetic risk score (2.29-14.34 risk alleles) and waist circumference (WC) (Pinteraction=1.66 × 10(-2)). Based on model predictions, for individuals with a higher TG genetic risk score (75th percentile=12), having an elevated WC (⩾80 cm) increased TG levels from 1.32 to 1.71 mmol l(-1). However, for individuals with a lower score (25th percentile=7), having an elevated WC did not significantly change TG levels. CONCLUSIONS: The TG genetic risk score interacted with adiposity to synergistically influence TG levels. For individuals with a genetic predisposition to elevated TG levels, our results suggest that reducing adiposity could possibly prevent further increases in TG levels and thereby lessen the likelihood of adverse health outcomes such as cardiovascular disease.

Parathyroid: The Pathology of Hyperparathyroidism.

This review focuses on the pathologic entities associated with hyperparathyroidism in humans. A discussion of the lesions, their embryology, and pathologic features is included. Immunohistology, cytopathology, and a brief overview of molecular aspects of the lesion are included.

Sonographic diagnosis of inferior mesenteric artery aneurysm and marginal artery of Drummond.

We report the case of a patient in whom sonographic examination revealed an aneurysm of the inferior mesenteric artery with severe proximal stenosis and poststenotic dilatation--the enlargement of the proximal portion of the artery of Drummond. This collateral pathway should be kept in mind when studying bowel ischemia, especially when stenosis is present or when there is occlusion of the superior mesenteric artery.

A rare and fatal complication of oesophagoscopy. Anaesthetic implications.

A 3.5-year-old child developed a tight oesophageal stricture following ingestion of caustic soda. At the end of the fourth anaesthetic for oesophageal dilatation, laryngospasm and difficulty in mask ventilation was followed by cyanosis, bradycardia, and cardiac arrest. Chest X ray showed a large pneumopericardium, which was immediately aspirated, but unfortunately resuscitation was unsuccessful. It was presumed that during attempted manual ventilation of the lungs in the presence of a closed glottis, air had been accidentally forced into the pericardium through a small tear in the fragile oesophagus.

Use of chloroprocaine for obstetric analgesia.

The effects of low concentration chloroprocaine in continuous lumbar epidural analgesia during labor and delivery, were evaluated in 21 subjects. The final analysis was made on 18 parturientis, 9 receiving 1.5% (group A) and 9 1.33% chloroprocaine (group B), in a standard dose of 7-8 ml (first test dose 2-3 ml), and of 12 ml for the second stage of labor. Onset of analgesia occurred 7.4 +/- 1.2 (mean +/- S.D.) (group A) and 9.6 +/- 1.8 min. (group B) after injection (difference significant). Mean interval between first and second doses was 50.5 +/- 6.3 (group A) and 47.5 +/- 10.8 (group B) min. (difference N.S.). In group A 6 patients and in group B only 1 patient had a temporarily decrease in bloodpressure below 100 mm Hg. During routine monitoring, pathological F.H.R. patterns were recorded in 2 cases. Apgar scores and acid-base parameters were within normal limits in both groups (difference N.S.).

Effects of enflurane (Ethrane) anesthesia on children during short surgical procedures.

Enflurane, a new inhalation anesthetic agent, was administered as primary anesthetic agent to children undergoing elective surgery of +/- 20 minutes duration in Oto-Rhino-Laryngology. Induction was done by enflurane (0.2 - 3.5%) given in a mixture of 50% N2O/O2 and maintenance was done with 2% enflurane and N2O/O2 mixture. Induction and recovery were rapid and uneventful. Regarding the cardiovascular system, we observed, during the first ten minutes of anesthesia, a significant drop of blood pressure which almost always returned to normal when the surgical stimulus was applied. Respiratory depression was negligiable in the spontaneously breathing patients. No ECG changes were observed. Postanesthetic side effects were minimal. Keeping in view the reports of other authors and our own results, we conclude that enflurane is a safe and well suited anesthetic in pediatric anesthesia of relatively short duration with spontaneous respiration.

Use of ICI 35868 as an anesthetic induction agent.

ICI 35868 was used to induce anesthesia in 39 ASA I patients (9 male and 30 female, aged 17-64 years), scheduled to undergo minor surgical procedures. The first 6 patients were given 1.0 mg/kg, the next 22 1.5 mg/kg and the final 11 2.0 mg/kg ICI 35868 I.V. over 30 seconds, without premedication. Anesthesia was successfully induced in 100% of patients at 2.0 mg/kg, 81% at 1.5 mg/kg and 50% at 1.0 mg/kg. Pain at the injection site occurred in 23% of patients. There were no signs of venous damage postoperatively. A small transient fall in blood pressure and some respiratory depression were seen immediately after induction; transient apnoea occurred in 27% of patients given 1.5 mg/kg and 55% given 2.0 mg/kg. Other side effects were minor and of low incidence. Three minutes after induction of anesthesia, when assessments were complete, 23 patients were given a further dose of a conventional induction agent, as they were beginning to awaken, and anesthesia was maintained in all patients by inhalational techniques. There were no untoward events during maintenance of or on recover from anesthesia.