Evaluation of clinical manifestations of coronavirus delta variant in neonates admitted to a hospital in northern Iran during the sixth wave: A case series.

Eleven newborns infected with COVID-19 delta variant admitted to a hospital in northern Iran during the sixth wave were evaluated. Fever, poor breastfeeding, lethargy, and lung involvement were the most prevalent symptoms in COVID-19 delta variant infected neonates. Infected mothers may be a main cause of infection for neonates.

Neonatal appendicitis in northern Iran: A case report.

We presented a case of neonatal appendicitis in a 22-day-old premature infant. The patient developed abdominal distension and perforation was suspected. The patient was transferred to the operating room with a diagnosis of peritonitis. Normal bowel loops were seen during surgery. Gangrenous appendicitis was seen. An appendectomy was performed.

Characteristics and outcome of infants born to mothers with SARS-CoV-2 infection during the first three waves of COVID-19 pandemic in northern Iran: A prospective cross-sectional study.

Background: Despite the rapid increase in knowledge about coronavirus disease 2019 (COVID-19), there is limited data on vertical transmission, viral loads in mother-neonate pairs, and health outcomes. We aimed to describe the characteristics, viral loads, and short-and mid-term outcomes of neonates born to mothers with confirmed COVID-19 infection in northern Iran. Materials and methods: In a cross-sectional study, we prospectively collected and analyzed the clinical features, reverse transcription-polymerase chain reaction (RT-PCR) results, viral loads, and outcomes of 60 neonates delivered by 58 SARS-CoV-2 infected pregnant women in maternity hospitals of Mazandaran University of Medical Sciences (northern Iran) during first three waves of the pandemic from March 1 to December 31, 2020. We assessed neonates' short and mid-term outcomes up to 24 months after the pandemic. We also described the timing of mother-to-infant transmission based on the classification presented by the World Health Organization. Results: Of the 17767 deliveries, 58 mothers had confirmed and probable COVID-19 infection. Twenty (33.3%) neonates were positive for SARS-CoV-2, two of whom had possible in utero transmission. Twenty-five (41.2%) neonates were preterm, most of whom were born during the first and second waves in which mothers were critically ill. 19 (31.7%) patients needed resuscitation in the delivery room. 34 (56.7%) neonates were isolated in the neonatal intensive care unit. We observed a significant relationship between the maternal and neonatal viral load (correlation coefficient = 0.983, P = 0.00). No neonatal death was observed and all babies had a good outcome. Conclusions: The results showed that vertical transmission of SARS-CoV-2 is possible but rare. Regional factors and severity of mother's disease may influence the clinical course of neonates. With increasing experience, proper observance of health precautions, and rapid development of evidence-based response systems for regional and global disasters, the transmission rate of SARS-CoV-2 from mother to newborn is reduced.

The Effectiveness of Kangaroo Mother Care (KMC) on attachment of mothers with premature infants.

Objective: Attachment is a socio-emotional relationship between the mother and infant that increases the probability of a preterm infant's survival. This study aimed to evaluate the effectiveness of Kangaroo Mother Care (KMC) on maternal attachments of mothers with premature infants. Study design: This quasi-experimental study was performed on 100 mothers of premature infants who were admitted to neonatal intensive care units. A questionnaire comprising demographic information and the Maternal Attachment Scale were used as data collection tools. All data analysis was performed using SPSS software version 25. Significant level is considered P < 0.05. Results: After the intervention, the levels of maternal attachment of mothers in the intervention group were significantly higher than in the control group (47.7 ± 2.9vs. 40.4 ± 5.4, P = 0.003). After the intervention, the infants in the intervention group has a significantly higher number of breastfeeding than the control group (10.6 ± 1.8 vs. 8.2 ± 1.6, P = 0.000). Moreover, the infant of the intervention group had a statistically significant higher weight at discharge time (2164.4 ± 481.1 vs. 1965.2 ± 372, P = 0.042). Conclusion: The results of the present study showed that Kangaroo Mother Care can be used to improve the maternal attachments in mothers with premature infants. It improves the breastfeeding and weight gain status in infants as well.

Effective intubation technique to manage the airway obstruction in A case of Pierre Robin sequence: A case report.

The case was a 4-day-old boy referred to the hospital with a diagnosis of Pierre Robin Sequence and with airway Obstruction. Using a laryngoscope in the hyperextended position and putting pressure on the cricoid, the vocal cords were visualized, and with the help of an assistant, the intubation was performed.

Suicide due to fear of COVID-19, in the last month of pregnancy, leads to neonatal seizure: A case report.

INTRODUCTION: and importance: Limited data are available about various effects of COVID-19 on pregnancy. On the other hand, the COVID-19 pandemic could exacerbate anxiety or schizophrenia symptoms. CASE PRESENTATION: The patient is a 5-day-old newborn, whom his mother suffers from schizophrenia, depression and anxiety disorders. The young pregnant mother gets delusions of being infected with Covid-19, thus attempts suicide with Sertraline, Clonazepam, Quetiapine and Rispeirdone, although she was in the last week of pregnancy. The newborn baby referred to our neonatal ward with seizure and apnea. Phenytoin and caffeine were administered leading to some degree of symptom relief, but due to the dermatologic reactions of phenytoin, they were replaced with levetiracetam. CLINICAL DISCUSSION: The Covid-19 may increase levels of anxiety and depression or exacerbation of schizophrenia symptoms, especially in pregnant women suffering from mental disorders. In addition, there are evidence supporting the occurrence of neonatal malformations as a result of exposure to antipsychotic drugs during the first trimester of pregnancy. CONCLUSION: Investigating the role of antidepressant and antipsychotic drugs in the perinatal period, especially near delivery has received less attention so far; thus further studies are required to determine the safety of these drugs.

Mobile-Assisted Virtual Bonding Enables Breast Milk Supply in Critically Ill Mothers With COVID-19: A Reflection on the Feasibility of Telelactation.

The separation of the mother-infant pair during the immediate postpartum period has been shown to impair the initiation and sustenance of breastfeeding. For critically ill mothers with coronavirus disease 2019 (COVID-19), the imposed isolation generates anxiety for their health and that of the offspring. In this study, we present a few cases where a favorable outcome was observed through a telehealth initiative for mothers with severe COVID-19 pneumonia, which involved sharing pictures and videos of newborn infants with the mothers during the ongoing severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) pandemic in a maternity hospital in northern Iran. In addition to the subjective maternal wellbeing offered by the visual and auditory cues from the infant, this technology-assisted telelactation'/'mobile-lactation'/'e-lactation' could potentially enhance the mother's capacity to initiate emotional bonding with the infant and be an adjunct in achieving and maintaining her lactation goals while offering the best nutritional choice for the infant.

Clinical course, radiological findings and late outcome in preterm infant with suspected vertical transmission born to a mother with severe COVID-19 pneumonia: a case report.

BACKGROUND: Vertical transmission of coronavirus disease 2019 (COVID-19) from mother to newborn infant is doubtful, and very little is known about disease severity and neonatal outcome. CASE PRESENTATION: We present a preterm Iranian infant born to a Persian mother with severe COVID-19 pneumonia. The mother underwent cesarean delivery, and amniotic fluid yielded a positive result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcription polymerase chain reaction (RT-PCR). The newborn infant showed early-onset infection with SARS-CoV-2 confirmed on pharyngeal swabs by RT-PCR assay within 24 hours after birth, suggesting vertical transmission. Unfortunately, the mother died 14 days after delivery. We describe the clinical course and outcome of the infant up to 7 months of age. CONCLUSION: COVID-19 infection in pregnant women may increase maternal morbidity, mortality and possibly vertical transmission in severe cases. However, it does not seem to progress to serious early or late neonatal complications.

Congenital goiter in North of Iran: A case report.

Congenital goiter (CG) is one of the rarest disorders observed in a newborn at birth diagnosed with hypothyroidism. Considering the simultaneity of pregnancy and baby's hypothyroidism at birth, the goiter can be caused by diabetes during pregnancy and hypothyroidism emergence in the baby.

Injuries due to caustics ingestion in children: A psychological approach to the suspicion of childish jealousies.

Most injuries from caustics ingestion occur due to parental negligence, but other causes such as psychological tendency or childish jealousy or behaviour may be the major cause for harming. Here, we describe a case of injury in a neonate who ingested a caustic substance, probably induced by his brother, but not as a consequence of the negligence of his parents. The mother said she had fed the child toilet bleach instead of water and was very concerned about the child's condition. However, when the baby's older brother was interviewed he did not show concern and was very confused and provided contradictory responses about his knowledge of the poisoning. Later, it was revealed that the baby's brother had prepared the milk and knew what was in it. In our case, damage by caustics ingestion may have been intentional due to psychological problems in parents causing child abuse or in other children due to childish jealousy.

Correlation between serum vitamin D level and neonatal indirect hyperbilirubinemia.

BACKGROUND: Considering the significant prevalence of Neonatal Indirect Hyperbilirubinemia (NIH) and its irreversible neurological complications, identifying the factors involved in the prevalence of neonatal jaundice is essential. The present study was conducted to determine the relationship between serum vitamin D levels and the prevalence of NIH in infants admitted to Qods Hospital of Qazvin in Iran in 2015-16. METHODS: In this case-control study, 30 term infants with NIH (the case group) were compared with 30 healthy, non- icteric, term infants (the control group) in terms of serum levels of 25-hydroxyvitamin D. The results were analyzed and compared between the two groups using t-test and the Chi-square test. RESULTS: The mean and standard deviation of serum 25-hydroxyvitamin D levels were 10.76 ± 8.6 ng/dl in the case group and 14.88 ± 11.38 ng/dl in the control group. There were no significant differences between the two groups (P = 0.11). CONCLUSION: The results suggest the lack of a relationship between vitamin D levels and NIH. However, further prospective studies are needed to conclude that vitamin D has no role in the pathogenesis of NIH.

Gender determination from diagnostic factors on anteroposterior pelvic radiographs.

BACKGROUND: Gender determination from skeletal remains is one of the primary factors in forensic medicine. This study aimed to identify the gender of patients referred to the radiology ward of the Rasoul Akram Hospital of Tehran using anteroposterior pelvic radiography. METHODS: A total of 200 patients (100 male and 100 female) referred to the radiology ward of the Rasoul Akram Hospital for anteroposterior pelvic radiography during 2013-2014 were included in this study. After taking a standard radiographic image of all patients in the supine position and an anteroposterior view of the pelvis, factors including subpubic angles, pubic angle, X angle, ischiopubic index, ratio of the length of the symphysis pubis to the mid and minimum width of the pubis body, and ratio of the length of the symphysis pubis to the minimum width of the pubic superior ramus were measured on radiographs. The Student t test and receiver operating characteristic curve were used to compare the data of male and female patients. Values were significant at p<0.05. RESULTS: All the evaluated variables were significantly different in male and female patients (p=0.000), with the highest level of measurement accuracy noted in the subpubic angle, Pubic Angle 1, X angle, Pubic Angle 2, minimum width of the pubic superior ramus, and ischiopubic index. Length of the symphysis pubis, length of the pubis, and ratio of the length of the pubis to the minimum width of the pubic superior ramus showed the lowest accuracy. CONCLUSION: The results of this study revealed that the evaluation of the radiographic images of pelvic bones by assessing the mentioned factors can be useful for sex determination from skeletal remains. However, ethical considerations should also be taken into account while using these factors.

Sudden Death Due to Association between NAFLD and Cardiovascular Changes in a 37-Year-Old Man: a Case Report.

Fatty liver disease (FLD) is the most prevalent form of liver disease worldwide. Overnutrition can induce nonalcoholic fatty liver disease (NAFLD), a spectrum of conditions ranging from simple steatosis [or nonalcoholic fatty liver (NAFL)] to nonalcoholic steatohepatitis and cirrhosis. Some of the epidemiological and pathological studies have also suggested an association between the presence of fatty liver and sudden death. A 37-year-old man was found dead when he was asleep in the bed at home. According to his family, he was single and a costermonger. He was not an athlete, and there was no history of any physical and mental disorder. He was not addicted and did not use any drugs or alcohol. The positive points, in this case, were: a large heart with mild coronary stenosis and steatohepatitis in autopsy and sudden death. Since steatohepatitis did not have any complication such as fat embolism, it can be concluded that the combination of steatohepatitis and cardiovascular disorder led to sudden unexpected death. Heart more than 450 gr is susceptible to arrhythmia, and fatty liver disease can cause cardiovascular changes.

Physical Spouse Abuse in a 28-Week-Pregnant Woman: A Case Report.

In some relationships, pregnancy is a risk factor for intimate partner violence (IPV). We present a case of a 34-year-old, 28-week-pregnant woman who was admitted to the emergency department with multiple traumas due to IPV. Her husband had hit her with a power cable after abusing methamphetamine. There were multiple ecchymoses and lacerations on her body. On questioning, the patient revealed a low socioeconomic status. The couple had been married for five years, and the abuse began 11 months earlier, after the husband became addicted to methamphetamines. In this instance of abuse, the husband was suspicious of the wife's pregnancy and believed that the child had been fathered by another man. Her husband's methamphetamine abuse had resulted in previous incidences of non-physical IPV, but, in the present incident, the combination of abuse coupled with partner jealousy resulted in physical abuse. During admission, there were no significant changes to the patient's health, and the fetus was deemed to be healthy and unharmed. After discharge, the patient decided to divorce her abusive husband. Screening and counseling for interpersonal and domestic violence is especially recommended during pregnancy to protect the mother and her fetus. In Iranian civil law, IPV is regarded as "osr-o-haraj" or severe and intolerable hardship, and women may cite it as grounds for divorce in cases such as spousal drug addiction and certain forms of spousal abuse. When intimate partner assault is repeated and petition for khula is presented to the courts, the court can order the man to divorce his wife and, if he refuses, the court judge can grant the khula without the husband's consent.

A 37-year-old woman found dead in a Jacuzzi: A case report.

One of the main problems in forensic medicine is the autopsy diagnosis of drowning, especially in the case of delay in the victim's recovery. The body of a 37-year-old woman was delivered to Kahrizak autopsy centre for post mortem. She was drowned in a public Jacuzzi because when she bent down to pick up her hairpin from the bottom of the Jacuzzi, her right arm became stuck in the drainage pipe and was sucked in. Unfortunately, she was not resuscitated after being pulled out of the Jacuzzi. The ambulance arrived too late, and she was already dead on arrival at the hospital. Her family pursued a claim against the managers and personnel of the pool for poor security management and failure to resuscitate. A forensic examination was needed to determine the manner of her death (natural, accidental, suicide and homicide).

Characteristics of Traumatic Brain Injury among Accident and Falling Down Cases.

Motor vehicle and falling down are responsible for the most number of traumatic injuries. This study aimed to compare the characteristics of traumatic brain injury among accident and falling down cases. In this analytical cross-sectional study, data were collected from the records of cadavers who died due to accident or falling down and referred to Kahrizak dissection hall, Tehran forensic medicine organization during 2013. A total of 237 subjects (183 (77.2%) accident and 54 (22.8%) falling down) with a mean age of 35.62 (SD=15.75) were evaluated. A number of 213 (89.9%) were male. From accident group, scalp injury was seen in 146 (79.8%), scalp abrasion in 122 (66.7%), scalp laceration in 104 (56.8%), sub skull bruising in 176 (96.3%), skull fracture in 119 (65%), hemorrhage in 166 (90.7%), Subdural hemorrhage (SDH) in 155 (84.7%), Subarachnoid hemorrhage (SAH) in 161 (88%), Epidural hemorrhage (EDH) in 41 (22.4%), contusion in 140 (76.5%), and skull base fracture in 140 (76.5%) of cases. In falling down group scalp injury was seen in 42 (77.8%) cadavers, scalp abrasion in 38 (70.4%), scalp laceration in 30 (55.6%), sub skull bruising in 49 (90.7%), skull fracture in 39 (72.2%), Hemorrhage in 49 (90.7%), SDH in 43 (79.6%), SAH in 47 (87%), EDH in 10 (18.5%), contusion in 33 (61.1%), and skull base fracture in 39 (72.2%) of cases. There was no significant difference between these two groups (P Value> 0.05). Accident and falling down had no difference in terms of any injury or hemorrhage.

Therapeutic and Ethical Dilemma of Puberty and Menstruation Problems in an Intellectually Disabled (Autistic) Female: a Case Report.

Intellectual disability is a term used when a person has certain limitations in mental functioning and skills. Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). Teenagers with learning and physical disabilities are more likely to have menstrual problems compared to the general populations. The parents of a 12-year-old girl with autism spectrum disorder and intellectual disability referred to the coroner due to her numerous problems of puberty (menstruation) including: poor hygiene and polluting herself and the environment, not allowing to put or change the pads and changes in mood and physical health prior period, requested for the surgery (hysterectomy). In legal medicine organization after reviewing the medical records, physical exams and medical consultations with a gynecologist and psychiatric, surgery was not accepted. Hysterectomy (surgery) due to the age of the child, either physically or morally is not recommended. The use of hormone replacement therapy has side effects such as osteoporosis. In these cases, it seems noninvasive methods (behavioral therapy and learning care skills) under the welfare experts is also more effective and morally.

Evaluation of specificity and sensitivity of gastric aspirate shake test to predict surfactant deficiency in Iranian premature infants.

INTRODUCTION: Respiratory failure secondary to pulmonary surfactant deficiency is an important cause of severe respiratory distress in term and preterm infants. The aim of this study was to evaluate the specificity and sensitivity of gastric aspirate shake test (GAST) to predict surfactant deficiency in newly born premature infants in Arash Hospital (Iran) during 2012-13. METHODS: In this case-control study, the case group comprised 69 premature infants (gestational age<37 weeks) who were admitted to the neonatal intensive care unit due to respiratory distress. The control group included 50 healthy infants .GAST test was done. The subjects were finally categorized as healthy or surfactant-deficient based on clinical and radiological assessments. RESULTS: Using statistical methods the sensitivity, specificity, and positive and negative predictive values of GAST were 60%, 75%, 15%, and 52%, respectively. There was a significant difference between respiratory distress syndrome (RDS) scores and receiving surfactant in neonates with gestational age below 34 weeks. Moreover, there were significant differences between GAST results and both radiological findings of RDS and receiving oxygen in premature infants (gestational age<34 weeks). Negative GAST results were more prevalent in neonates who were born to mothers with hypothyroidism, preeclampsia, diabetes mellitus, and premature rupture of membranes. However, this difference was not significant. CONCLUSION: According to our findings, the application of GAST on gastric aspirate secretions is not a useful method to predict surfactant deficiency. Therefore, decisions for RDS management must be made based on clinical and radiological findings.