The Burden of Childhood Iron Deficiency Anemia in a Developed Country: A Croatian Tertiary Care Center Experience.

BACKGROUND: Given the high prevalence of unrecognized iron deficiency anemia (IDA) in Croatia and its negative impact on children's somatic and neurological outcomes, a comprehensive preventive and treatment approach is a necessity.  Methods: This was an observational, cross-sectional study of pediatric patients referred to the Children's Hospital Zagreb, Croatia, from 2017 to 2021, for IDA. Epidemiological and clinical data were extracted. Laboratory workup and therapeutic actions in the primary and tertiary care settings were recorded. The need for transfusion, parenteral iron therapy, and hospital admission was noted. RESULTS: A total of 299 patients (52.2% female, median five years) were seen by the hematologist in the five-year study period. Almost half (45.1%) were referred by the primary care pediatrician. Only half of the patients (56.6%) received oral iron therapy prior to referral. The preferred preparation was Dextriferron (67.7%) during the mean period of 5.8 months, but more than one-third of the patients (36.5%) were non-compliant. Every 10th child seen by the hematologist for IDA was admitted to the hospital; 6.4% required transfusion therapy, and in only one patient, parenteral iron was administered.  Conclusions: The results of this survey established that IDA still represents an excessive burden in a tertiary care setting of a high-income country. Therefore, consistent implementation of national guidelines and additional education of primary healthcare providers is crucial to ameliorate this significant public health concern.

The influence of the fundal pressure manoeuvre at delivery on the anal sphincter injury diagnosed with endoanal ultrasonography.

OBJECTIVES: The fundal pressure manoeuvre (FPM) is a procedure where the fundus of the uterus is pushed through the abdominal wall by the midwifes and doctors to shorten the terminal phase of the second stage vaginal delivery. Nowadays its use is controversial and associated with many adverse effects. The aim of the study was to evaluate benefits and adverse maternal outcomes after FPM. The correlation of the FPM with episiotomy was evaluated. The role of the FPM on pelvic floor dysfunction such as anal incontinence due to anal sphincter injury was assessed. STUDY DESIGN: The retrospective study was conducted between 2017 and 2021. The women who came to the postpartum examination to Gynaecology department for various reasons and gave vaginal birth to a singleton were included in the study. The women who had instrumental delivery were excluded. Minimal sample size was calculated with calculator.net and set on 45. Two groups were formed one with fundal pressure and one without, 96 and 90 patients respectively. The maternal, fetal, and obstetric factors that could be associated with the application of FPM were examined. The endoanal ultrasound examination was performed on all women included in the study. RESULTS: The study did not show that FPM would lead to a more frequent occurrence of anal sphincter injury (p = 0.73), effect its location (p = 0.77) and depth (p = 0.97), however the test group tended to have longer ruptures compared to control group (p = 0.1). No statistically significant differences in episiotomies between control and test group (p = 0.075) were shown. Endoanal ultrasound showed discrepancy between clinically stated and ultrasonographical diagnoses of anal sphincter injuries. In 61,3% of patients with anal sphincter injury after FPM, reported one of the anal incontinence problems of varying degrees six months after delivery. CONCLUSION: Given that the study proved that FPM is not correlated to the anal sphincter injury it can be used safely. The FPM should be performed carefully and only if necessary to safely finish the labour or in combination with instrumental delivery.

Advanced Treatment Options of Pyoderma Gangrenosum Ulcers.

INTRODUCTION: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis often associated with autoimmune disease that, despite published literature, still poses diagnostic and therapeutic challenges due to its lack of serological and histological markers and wide possibility of differential diagnosis. Although immunosuppressive therapy usually is the first-line treatment, it has a long-lasting, unpredictable treatment course, thus necessitating the need for new treatment options. This report highlights 2 cases of PG ulcers treated with different methods that show a potentially faster healing time, as well as a review of advanced treatment options for PG. CASE REPORTS: Two men (21 years old and 64 years old) presented with PG ulcers and underwent 2 different treatment courses. The 21-year-old man received negative pressure wound therapy (NPWT) with a nonadhesive, less-invasive, skin-contact interface layer on the polyurethane foam. Stimulated growth of granulation tissue accelerated healing and prepared the wound bed for further epithelization. The second patient, the 64-year-old man, underwent treatment with autologous platelet-rich fibrin, which supplied the ulcer with growth factors and accelerated epithelialization. CONCLUSIONS: The new possibilities offered by NPWT with nonadhesive foam and regenerative medicine are typically affordable, effective, safe, and painless for the patient. Both methods were noninvasive, did not accelerated the pathergy phenomenon, and showed a potential for faster healing of PG ulcers.

Can we predict obstetric anal sphincter injury?

OBJECTIVE: The aim of the study was to identify primiparous pregnant women with a higher risk for obstetric anal sphincter injuries (OASIS) based on obstetric characteristics (risk factors). STUDY DESIGN: In the retrospective case control study primiparous women were examined using endoanal ultrasonography (EUS) for OASIS identification 6-12 weeks after delivery. Obstetric characteristics for OASIS were collected from the mothers' medical records. The univariate analysis of maternal (age at delivery, maternal height, weight, BMI), infant (length, weight and head circumference) and birth (pregnancy duration, labour and delivery duration, episiotomy, vacuum extraction and oxytocin augmentation) risk factors, Pearson correlations and information gain were carried out. The cut-off values for the aforementioned risk factors divided the patients into groups with higher and lower risk of OASIS. RESULTS: The data of 84 primiparous women with OASIS, and 58 without, were analysed. Those newborns born to women in the OASIS group were heavier (P<0.05), with the cut-off at 3420g (72% probability of OASIS), had a larger head circumference (P<0.001), cut-off at 36cm (84% probability of OASIS), and were longer (P<0.05), cut-off at 50.5cm (74% probability of OASIS). The maternal age and body mass index (BMI) were risk factors for OASIS (P<0.05 and P<0.05, respectively) with a probability of 83% in women younger than 27.5 years and a 78% probability if BMI was higher than 28kg/m2. The incidence of OASIS was not higher in women with episiotomy or vacuum extraction, but it was higher in oxytocin augmentation (P<0.031). CONCLUSION: The findings can assist in identification of pregnant women with a higher risk of OASIS who require special attention at delivery to prevent it. In high risk women EUS is indicated to identify and treat possible OASIS as early as possible in order to prevent anal incontinence.