Early Transient Hypoglycemia and Test Performance in At-Risk Newborns.

OBJECTIVE: This study aimed to evaluate if early (within the first 3 hours after birth) transient neonatal hypoglycemia (TNH) is associated with poor academic performance in infants at-risk for hypoglycemia. STUDY DESIGN: This was a retrospective cohort study of at risk-infants (late preterm infants, small and large for gestational age infants, and infants of diabetic mothers [IDMs]) who were born in 1998 and 1999 at the University of Arkansas for Medical Sciences and had ≥1 recorded glucose concentration. The outcome measure was proficiency on 4th grade literacy and mathematics achievement tests. Three glucose concentration cutoffs for defining hypoglycemia (<35, <40, and <45 mg/dL) were investigated. Logistic regression models were developed to examine the association between early TNH and achievement test proficiency based on perinatal factors. RESULTS: Among 726 infants, 472 had one, 233 had two, and 21 had three risk factor(s). Early TNH (glucose concentration <35, <40, and <45 mg/dL) was observed in 6.3, 11.6, and 20.5% of the study cohort, respectively. Irrespective of the cutoff used, the frequency of early TNH (number of patients with early TNH in a risk category divided by the total number of patients in that category) was significantly greater among infants with multiple risk factors. After controlling for perinatal factors, early TNH (cutoffs <35 and <40 mg/dL) was significantly associated with decreased probability of proficiency in literacy but not mathematics. Despite that early TNH was more common in IDMs and infants with three risk factors, the category or number of risk factors did not impact academic proficiency. CONCLUSION: Early TNH (<35 and <40 mg/dL) was associated with lower adjusted probability of proficiency on 4th grade literacy achievement tests in at-risk infants. The impact of early TNH on academic performance was similar irrespective of category or number of risk factors. KEY POINTS: · Transient hypoglycemia was associated with lower proficiency on 4th grade tests in at-risk infants.. · The category of risk factors among at-risk infants did not impact 4th grade academic proficiency.. · The number of risk factors among at-risk infants did not impact 4th grade academic proficiency..

Neuraxial Analgesia in Pregnant Hispanic Women: An Assessment of Their Beliefs and Expectations.

BACKGROUND: The presence of racial/ethnic disparities in the use of neuraxial labor analgesia for childbirth has been previously described. The purpose of this study was to assess the childbirth pain management beliefs among a small sample of pregnant Hispanic women and to evaluate the Spanish translation accuracy of the Childbirth Pain Scale (CPBS). METHODS: To collect data, we interviewed 20 pregnant Spanish-speaking women using an interview guide, a demographic datasheet, and the CPBS a 15-item survey. Interviews were transcribed verbatim, translated, and uploaded to ethnograph v6. Descriptive statistics and thematic analysis were used to analyze the data. RESULTS: Most of the participants were from Mexico (n=16) and Central America (n=4), mean age was 28.3, and all (n=20) spoke Spanish as their primary language. In this sample, 80% of nulliparous and 100% of multiparous women saw pain as having a positive role in delivery. Four major themes emerged from the data: Theme 1: Normalcy of childbirth pain (pain is good), Theme 2: Availability and role of pain medication, Theme 3: Naturalistic strategies to endure pain, and Theme 4: Fear of the unknown/childbirth process. In this sample, 18 of 20 women stated they did not want epidural analgesia unless medically indicated. During labor and delivery 100% of nulliparous and 25% of multiparas chose to receive epidural analgesia. No changes were requested by the participants regarding the translation of the CPBS. CONCLUSION: Childbirth pain was seen as a valuable component of the birthing process. The majority of participants believed pain medication should be avoided unless medically necessary. These results suggest that racial/ethnic disparities in the use of epidural analgesia may partially reflect patient beliefs and preferences. It is crucial to be aware of these differences to optimize shared decision-making for women in this vulnerable patient population.

Fracaso renal agudo en pacientes con mieloma: Nuestra experiencia con hemodiálisis extendidas con dializadores de alto poro / Acute renal failure in patients with myeloma: Experience with extended high cut-off hemodialysis

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Calcificaciones mamarias en pacientes tratadas con hemodiálisis: estudio descriptivo / Breast calcifications in patients undergoing hemodialysis: a descriptive study

Con el objetivo de estudiar la frecuencia y las características de las calcificaciones mamarias de las enfermas en hemodiálisis, se investigaron 26 pacientes tratadas en nuestro hospital. Para ello, se realizaron mamografías en dos proyecciones de todas las pacientes. A una de ellas se le realizó una biopsia con aguja gruesa y un análisis histológico del material extraído. El 53,8% de las enfermas presentaban calcificaciones en las mamas, todas de características benignas. Se clasificaron en vasculares (64,28%), intersticiales (42,85%) y ductales (5,31%).En el 50% de los casos aparecían varias de ellas de forma simultánea. La presencia de calcificaciones intersticiales lo consideramos un hallazgo especialmente interesante, ya que no las detectamos en el grupo control. En el estudio, la frecuencia y el número de las calcificaciones se relacionan con la edad y con el tiempo en diálisis, no así con el producto calcio/fósforo ni con las cifras de PTH

Twenty-six patients treated at our hospital were studied to evaluate the frequency and characteristics of breast calcifications in patients undergoing hemodialysis. All patients underwent two-view mammography and one underwent core-needle biopsy. Breast calcifications were present in 53.8%; all calcifications had benign mammographic appearance. Calcifications were classified as vascular (64.28%), interstitial ( 42.85%), and ductal (5.31%).Calcifications were multiple in 50% of cases. We consider the presence of interstitial calcifications to be especially interesting, as none were detected in the control group. In this study, the frequency and number of calcifications correlated with age and time under dialysis but not with the calcium/phosphorous ratio or parathyroid hormone (PTH) values