Neonatal thyrotropin levels and auditory neural maturation in full-term newborns.

OBJECTIVE: This study aimed to look for a possible relationship between thyrotropin (TSH) values from neonatal bloodspot screening testing and newborn lower auditory pathway myelinization evaluated using the brainstem evoked response audiometry (ABR) test. METHODS: Sixty-two healthy full-term newborns without perinatal problems were enrolled in the study. TSH results were collected from neonatal bloodspot screening data and were below the test cut-off level (15µUI/mL). The TSH test was performed between three and seven days, and the ABR test was performed in the first 28 days of life. The newborns were divided into two groups: Group 1 (n = 35), TSH between 0 and 5µUI/mL, and group 2 (n = 27), TSH between 5 and 15µUI/mL. Data are presented as mean ± SD, median, or percentage, depending on the variable. RESULTS: Wave latency and interpeak interval values for Groups 1 and 2 were as follows: Wave I: 1.8 ± 0.1 and 1.7 ± 0.1; Wave III: 4.4 ± 0.1 and 4.4 ± 0.1; Wave V: 6.9 ± 0.1 and 6.9 ± 0.1; interval I-III: 2.6 ± 0.1 and 2.6 ± 0.1; interval I-V: 5.1 ± 0.1 and 5.1 ± 0.1; interval III-V: 2.4 ± 0.1 and 2.4 ± 0.1. There were no significant differences in ABR parameters between groups 1 and 2 (p > 0.05). Multiple regression analysis showed a slight significant negative correlation between TSH and wave I values (standardized ß = -0.267; p = 0.036), without observing any relationship with the other ABR waves recorded. CONCLUSIONS: This study investigated the relationship of TSH and auditory myelinization evaluated by ABR. It did not show a significant change in lower auditory pathway myelinization according to TSH levels in newborns with TSH screening levels lower than 15 µUI/mL.

Effects of intrauterine latent iron deficiency on auditory neural maturation in full-term newborns.

OBJECTIVE: This study analyzed the relationship between latent iron deficiency evaluated by ferritin, and the myelination of the central nervous system evaluated through the brainstem evoked response audiometry test. METHOD: A total of 109 full-term newborns, born without anemia and risk factor for hearing deficiency, were enrolled. After delivery, umbilical cord blood was collected to determine ferritin and hematocrit levels. The brainstem evoked response audiometry test was carried out in the first 28 days of life. Analysis was performed between the control group (n=71) with ferritin greater than 75ng/mL, and the latent iron deficiency group (n=38) with ferritin between 11 and 75ng/mL. Results were presented as mean±standard deviation. Statistical analysis was performed using GraphPad prism7 and SPSS with a significance level of 5%. RESULTS: A significant higher V-wave (p=0.02) and interpeak intervals I-III (p=0.014), I-V (p=0.0003), and III-V (p=0.0002) latencies were found in the latent iron deficiency group, as well as a significant inversely proportional correlation between ferritin and the same wave and intervals (p=0.003, p=0.0013, p=0.0002, p=0.009, respectively). Multiple correlation analysis showed a significant correlation of latent iron deficiency with all interpeak intervals, even taking into account newborn gestational age. CONCLUSION: Iron deficiency anemia is a prevalent pathology; this study showed auditory delayed maturation associated to intrauterine iron deficiency, even in its latent form. This reinforces the importance of adopting effective measures, on a global scale, to prevent and treat this pathology in different life periods, especially in the most vulnerable population.

Obstrução duodenal por cálculo - síndrome de bouveret: um relato de caso / Duodenal obstruction by calculus - bouveret syndrome: a case report

Introdução: A Síndrome de Bouveret é uma complicação rara, causada por um cálculo biliar grande que obstrui o intestino por meio de uma fístula e tem como principais sintomas: náuseas, vômitos, dor abdominal e distensão. O diagnóstico é feito por meio de exames de imagem, o tratamento é desafiador e pode envolver cirurgia ou procedimentos endoscópicos. Tem morbimortalidade considerável, mas a falta de diretrizes padrão dificulta o diagnóstico e o tratamento. Objetivos: Apresentar um relato de caso de paciente com características fisiopatológicas e diagnóstico de Síndrome de Bouveret, discutir a sintomatologia clínica, diagnóstico, tratamento e o desfecho cirúrgico. Método: Relato de caso realizado por revisão de prontuário e exames de paciente com síndrome de Bouveret. Apresentação: Feminina, 62 anos, quadro clínico compatível com obstrução duodenal. Tomografia de abdômen: imagem ectópica radiopaca, distensão hidroaérea intestinal, sugerindo cálculo biliar, confirmada através de endoscopia digestiva alta. Submetida a gastrotomia, seguida de gastrorrafia, sem reparo da fístula colecistogástrica. Discussão: Síndrome de Bouveret é mais comum em idosos e mulheres com antecedentes de cálculos biliares grandes. O diagnóstico é feito por meio de exames de imagem, geralmente por tomografia computadorizada e o tratamento visa remover o cálculo e aliviar a obstrução intestinal de maneira menos invasiva possível. Por alto risco cirúrgico, o tratamento endoscópico por meio de métodos como retirada com cesta ou litotripsia é indicado, porém, requer múltiplos procedimentos e possui limitações. A abordagem cirúrgica pode ser realizada em um ou dois tempos, dependendo das condições do paciente. Conclusão: Exames de imagens aliados à clínica são essenciais para o diagnóstico e tratamento com gastrostomia e o reparo de fistula em dois tempos se mostra uma ótima opção

Introduction: Bouveret syndrome is a rare complication, caused by a large gallstone that obstructs the intestine through a fistula and has as main symptoms: nausea, vomiting, abdominal pain and distension. The diagnosis is made through imaging tests, the treatment is challenging and may involve surgery or endoscopic procedures. It has considerable morbidity and mortality, but the lack of standard guidelines makes diagnosis and treatment difficult. Objectives: To present a case report of a patient with pathophysiological characteristics and diagnosis of Bouveret syndrome, to discuss the clinical symptomatology, diagnosis, treatment and surgical outcome. Method: Case report performed by review of medical records and examinations of patients with Bouveret syndrome. Presentation: Female, 62 years old, clinical picture compatible with duodenal obstruction. Abdominal CT scan: radiopaque ectopic image, intestinal hydrorespiratory distension, suggesting gallstone, confirmed by upper digestive endoscopy. Submitted to gastrotomy, followed by gastrorraphy, without repair of the cholecystogastric fistula. Discussion: Bouveret syndrome is more common in the elderly and women with a history of large gallstones. The diagnosis is made through imaging tests, usually by computed tomography and the treatment aims to remove the stone and relieve intestinal obstruction in the least invasive way possible. Due to high surgical risk, endoscopic treatment through methods such as basket removal or lithotripsy is indicated, however, it requires multiple procedures and has limitations. The surgical approach can be performed in one or two times, depending on the patient's conditions. Conclusion: Imaging exams combined with the clinic are essential for diagnosis and treatment with gastrostomy and two-stage fistula repair is a great option

Introducción: El Síndrome de Bouveret es una complicación rara, causada por un gran cálculo biliar que obstruye el intestino a través de una fístula y tiene como síntomas principales: náuseas, vómitos, dolor abdominal y distensión. El diagnóstico se realiza a través de pruebas de imagen, el tratamiento es desafiante y puede involucrar cirugía o procedimientos endoscópicos. Tiene una morbilidad y mortalidad considerables, pero la falta de pautas estándar dificulta el diagnóstico y el tratamiento. Objetivos: Presentar un reporte de caso de un paciente con características fisiopatológicas y diagnóstico de Síndrome de Bouveret, discutir la sintomatología clínica, diagnóstico, tratamiento y resultado quirúrgico. Método: Reporte de caso realizado mediante revisión de historias clínicas y exámenes de un paciente con síndrome de Bouveret. Presentación: Mujer, 62 años, cuadro clínico compatible con obstrucción duodenal. Tomografía de abdomen: imagen ectópica radiopaca, distensión intestinal hidroaérea, sugestiva de cálculos biliares, confirmada por endoscopia digestiva alta. Sometido a gastrotomía, seguida de gastrorrafia, sin reparación de la fístula colecistogástrica. Discusión: El síndrome de Bouveret es más común en ancianos y mujeres con antecedentes de cálculos biliares grandes. El diagnóstico se realiza mediante pruebas de imagen, generalmente por tomografía computarizada, y el tratamiento tiene como objetivo eliminar el cálculo y aliviar la obstrucción intestinal de la forma menos invasiva posible. Debido al alto riesgo quirúrgico, está indicado el tratamiento endoscópico mediante métodos como la extracción con canastilla o la litotricia, sin embargo, requiere múltiples procedimientos y tiene limitaciones. El abordaje quirúrgico se puede realizar en una o dos etapas, dependiendo de las condiciones del paciente. Conclusión: Los exámenes de imagen combinados con la clínica son fundamentales para el diagnóstico y tratamiento con gastrostomía y la reparación de fístulas en dos tiempos demuestra ser una gran opción.

Effects of intrauterine latent iron deficiency on auditory neural maturation in full-term newborns / Efeitos da deficiência de ferro latente intrauterino na maturação neural auditiva em recém-nascidos a termo

Abstract Objective: This study analyzed the relationship between latent iron deficiency evaluated by ferritin, and the myelination of the central nervous system evaluated through the brainstem evoked response audiometry test. Method: A total of 109 full-term newborns, born without anemia and risk factor for hearing deficiency, were enrolled. After delivery, umbilical cord blood was collected to determine ferritin and hematocrit levels. The brainstem evoked response audiometry test was carried out in the first 28 days of life. Analysis was performed between the control group (n = 71) with ferritin greater than 75 ng/mL, and the latent iron deficiency group (n = 38) with ferritin between 11 and 75 ng/mL. Results were presented as mean ± standard deviation. Statistical analysis was performed using GraphPad prism7 and SPSS with a significance level of 5%. Results: A significant higher V-wave (p = 0.02) and interpeak intervals I-III (p = 0.014), I-V (p = 0.0003), and III-V (p = 0.0002) latencies were found in the latent iron deficiency group, as well as a significant inversely proportional correlation between ferritin and the same wave and intervals (p = 0.003, p = 0.0013, p = 0.0002, p = 0.009, respectively). Multiple correlation analysis showed a significant correlation of latent iron deficiency with all interpeak intervals, even taking into account newborn gestational age. Conclusion: Iron deficiency anemia is a prevalent pathology; this study showed auditory delayed maturation associated to intrauterine iron deficiency, even in its latent form. This reinforces the importance of adopting effective measures, on a global scale, to prevent and treat this pathology in different life periods, especially in the most vulnerable population.

Resumo Objetivo Este estudo analisou a relação entre deficiência de ferro latente avaliada pela ferritina e a mielinização do sistema nervoso central avaliada pelo teste de Potenciais Evocados Auditivos de Tronco Encefálico. Método Foram incluídos no estudo 109 recém-nascidos a termo, nascidos sem anemia e fator de risco para deficiência auditiva. Após o parto, o sangue do cordão umbilical foi coletado para determinar os níveis de ferritina e hematócrito. O teste de Potenciais Evocados Auditivos de Tronco Encefálico foi realizado nos primeiros 28 dias de vida. A análise foi realizada entre o grupo controle (n = 71) com ferritina acima de 75 ng/mL e o grupo com deficiência de ferro latente (n = 38) com ferritina entre 11 e 75 ng/mL. Os resultados foram apresentados como média ± desvio-padrão. A análise estatística foi realizada utilizando o software GraphPad prism7 e SPSS com nível de significância de 5%. Resultados Latências significativamente maiores da onda V (p = 0,02) e dos intervalos interpicos I-III (p = 0,014), I-V (p = 0,0003) e III-V (p = 0,0002) foram encontradas no grupo de deficiência de ferro latente, assim como uma correlação significativa inversamente proporcional entre a ferritina e a mesma onda e intervalos (p = 0,003, p = 0,0013, p = 0,0002, p = 0,009, respectivamente). A análise de correlação múltipla mostrou uma correlação significativa da deficiência de ferro latente com todos os intervalos interpicos, mesmo se levarmos em consideração a idade gestacional do recém-nascido. Conclusão A anemia ferropriva é uma patologia prevalente e este estudo demonstrou maturação auditiva tardia associada à deficiência intrauterina de ferro, mesmo em sua forma latente. Isso reforça a importância da adoção de medidas efetivas, em escala global, para prevenir e tratar essa patologia em diferentes períodos da vida, principalmente na população mais vulnerável.