RESUMEN
Objective: Intraventricular hemorrhage (IVH) is a significant concern for premature very low birth weight (VLBW) neonates worldwide. Recently, the popular theory of the benign nature of low-grade IVH has been argued with uncertain outcomes. This study aimed to assess the effect of low-grade IVH on the neurodevelopment of VLBW neonates. Materials & Methods: This six-month follow-up cohort study was conducted on VLBW neonates with and without grade I-II IVH diagnosed through brain ultrasonography. Participants were neurologically examined at birth and within six months. Neurodevelopment was assessed using the Bayley-III questionnaire, which includes evaluating cognition, receptive language, expressive language, fine motor, and gross motor performance. Results: A total of 100 VLBW neonates were recruited, including 40 cases with grade I-II IVH diagnosed through brain ultrasonography and 60 controls. Cases and controls were similar in terms of gestational age, body birth weight, hospitalization duration, gender distribution, and age at Bayley-III evaluation (P>0.05). The neurological assessments at birth showed no significant difference between the two groups (P=0.20), while controls showed significantly better results at the sixth month of age (P =0.004). Concerning different neurodevelopmental indices, after adjusting for demographic characteristics and respiratory-related variables at the time of Bayley-III evaluation, controls presented a higher performance in cognition and gross motor aspects compared to cases (P= 0.04 and 0.03, respectively). Conclusions: The low-grade IVH affected the sixth-month neurological examination and gross motor performance of the VLBW newborns. Notably, cognition and gross motor were the two affected subscales in the presence of low-grade IVH, independent of demographic factors.
RESUMEN
Cushing's syndrome results from lengthy and inappropriate exposure to excessive concentrations of either endogenous or exogenous glucocorticoids. This study described 30 patients with a novel type of severe exogenous Cushing's syndrome in a group of intravenous drug users due to illicit use and dependence on a new opioid combination, Norjizak. Thirty consecutive patients (2 women and 28 men) who presented with a novel type of severe exogenous Cushing's syndrome and other complications were admitted to the emergency departments of Qom and Isfahan University of Medical Sciences, Isfahan, Iran, between September 2005 and September 2007 were enrolled. All participating patients were intravenous drug users who used a narcotic drug called Norjizak, a combination of different opioids with dexamethason or benzodiazepines. Patients were first evaluated and managed based on the current illness, and then entered into a detoxification program by a medical team. Clinical data were collected by an open interview and the patient's files using a standard form. High-performance liquid chromatography was used to determined glucocorticoid existence in the brand. The major complaints and clinical findings were withdrawal symptoms, severe edema, osteoporotic fracture, impairment in glucose tolerance, decreased libido, and sepsis (including necrotizing pneumonia, cutaneous infection, multivalvular endocarditis, osteomyelitis, and urogenital infection). Most patients had started with 2 or 3 vials per day and then increased the dose compulsively to maximum of approximately 15 to 20 vials per day. The concentration of Dexamethhasone disodium phosphate in each 2 mL vial was 0.4 to 1 mg/mL. Heroin was also found in them. We are witnessing a special exogenous Cushing syndrome due to the mixing of opiates and dexamethasone. Norjizak syndrome is the clinical condition of poisoning with a second material when it is combined with opiates due to compulsive dose increment and long duration.