RESUMO
Necrotizing enterocolitis (NEC) predominantly affects preterm infants and can mimic other conditions like acute appendicitis. Neonatal appendicitis (NA) is extremely rare, with an incidence of 0.04-0.2% and high fatality rates. Due to its rarity and resemblance to other neonatal conditions, NA diagnosis is often delayed. We report a case of a 2220-g male preterm neonate delivered at 31 + 5 weeks via urgent cesarean section due to chorioamnionitis, initially misdiagnosed with NEC but later found to have a perforated appendix. The neonate recovered well post-surgery, with the ileostomy reversed 10 weeks later. Prompt surgical intervention is crucial for NA, as it requires different management than NEC. This case underscores the importance of considering NA in preterm infants with severe abdominal symptoms and emphasizes timely surgical intervention to improve outcomes. Additionally, it supports the hypothesis that localized NEC involving the appendix may have a better prognosis than generalized NEC.
RESUMO
PURPOSE: We sought to analyze the incremental economic burden of depression on adults with concurrent ophthalmic conditions in the United States. DESIGN: Retrospective cross-sectional study. METHODS: Using the Medical Expenditure Panel Survey from 2016 to 2018, ophthalmic patients with ≥1 outpatient visit were identified by International Classification of Diseases, 10th revision, Clinical Modification codes and stratified based on the presence of concurrent depression. A multivariate 2-part regression model was used to determine incremental economic burden, health care sector utilization, and expenditures. RESULTS: Of 7279 ophthalmic patients, 1123 (15.43%) were diagnosed with depression (mean expenditures $17,017.25 ± $2019.13) and 6156 patients (84.57%) without depression (mean expenditures $9924.50 ± $692.94). Patients with depression were more likely to be female, white, lower income, use Medicare/Medicaid, and to have comorbidities (P < .001). These patients faced $5894.86 (95% confidence interval $4222.33-$7348.36, P < .001) in incremental economic expenditures because of depression, resulting in an additional $22.4 billion annually when extrapolating nationally. These patients had higher utilization for all health care service sectors (P < .025 for all) and higher expenditures for outpatient (P = .022) and prescription medications (P = .029) when adjusted for sociodemographic variables and comorbidities. Depression was responsible for 6.9% of inpatient admissions (the second-leading cause) for this cohort of patients. CONCLUSION: Ophthalmic patients with depression had a higher incremental economic burden and health care service sector utilization and expenditures. Patients with ophthalmic pathologies, including dry eye syndrome, blindness, and retinopathies, were more likely to be depressed. As psychiatric and ophthalmic conditions may have a bidirectional relationship, exacerbating disease severity and financial burden for patients with both, ophthalmologists may need to be more cognizant of the burden of depression among patients.