Prevalence of SARS-CoV-2 in newborns born to SARS-CoV-2-positive mothers at 2 weeks of life.

Introduction: Limited evidence exists on management recommendations for neonates born to SARS-CoV-2-positive mothers. This study looked at transmission risk of neonates presenting for primary care in a large regional health system within New York during the early months of the COVID-19 pandemic. Methods: This was a prospective, observational study of newborns born to SARS-CoV-2-positive mothers presenting at any of the 19 Northwell Health-Cohen Children's Medical Center primary care practices who underwent another oropharyngeal/nasopharyngeal swab for detection of SARS-CoV-2 by day of life (DOL) 14. Results: Among 293 newborns born to SARS-CoV-2-positive mothers who were negative at birth, 222 were retested at DOL 14, corresponding to times with different predominant strains. Of these, seven tested positive but had no symptoms. Conclusion: The overall low transmission rates and absence of symptomatic infection support the safety of direct breastfeeding after hospital discharge with appropriate hand and breast hygiene.

Long-Term Modulation of Appetitive Hormones and Sweet Cravings After Adjustable Gastric Banding and Roux-en-Y Gastric Bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) produces greater weight loss compared with a purely restrictive procedure such as laparoscopic adjustable gastric banding (LAGB). OBJECTIVE: The objective of this study was to quantify changes in hormones that regulate energy homeostasis and appetitive sensations before and after LAGB (n = 18) and RYGB (n = 38) in order to better understand the mechanisms underlying the greater weight loss after RYGB. METHODS: A standardized test meal was administered prior to surgery, at 6 months, and annually thereafter to year 2 after LAGB and year 4 after RYGB. Blood samples were obtained in the fasted state and 30, 60, 90, and 120 min post-meal. RESULTS: Progressive increases in fasting PYY were observed after RYGB together with increases in postprandial area under the curve (AUC) levels that were unchanged after LAGB. GLP-1 AUC increased only after RYGB. There was a weight loss-related increase in fasting ghrelin levels after LAGB that was unchanged 1 year after RYGB despite greater percentage weight loss; ghrelin subsequently increased at years 2-4 post-RYGB. HOMA-IR decreased after both procedures but correlated with weight loss only after LAGB, whereas leptin correlated with weight loss in both groups. Sweet cravings decreased after RYGB. CONCLUSION: A number of weight loss-independent changes in the gut hormonal milieu likely act in concert to promote a decrease in insulin resistance and greater weight loss efficacy after RYGB. A progressive change in hormone levels over time may reflect gut enteroplasticity after RYGB. A decrease in sweet cravings specific to RYGB may further promote superior weight loss outcomes.

Herlyn-Werner-Wunderlich syndrome: Diagnosis and treatment of an atypical case and review of literature.

INTRODUCTION: Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome, is a rare congenital abnormality of Müllerian duct development characterized by uterus didelphys, unilateral blind hemivagina, and ipsilateral renal agenesis. PRESENTATION OF CASE: In this report, the authors present the case of a 12-year-old patient presenting with progressive and disabling abdominal pain after the onset of menarche diagnosed with HWWS, describe the various diagnostic modalities and treatment options available, along with a current review of the literature. DISCUSSION: With normal external genitalia, HWWS is usually asymptomatic until menarche when patients present with worsening abdominal pain during menses and a palpable pelvic or abdominal mass. Untreated, HWWS may lead to a number of complications including endometriosis, infertility, and spontaneous abortion. CONCLUSION: Greater awareness of HWWS will lead to earlier detection and is the key to alleviating patient suffering and avoiding potentially severe complications.

Open Versus Laparoscopic Splenectomies in Children: A Comparative Study Performed at a Public Hospital in Brazil.

Introduction: In pediatric population, the two most common indications for splenectomy include traumatic rupture and hematological diseases such as hereditary spherocytosis, idiopathic thrombocytopenic purpura, sickle cell disease, and autoimmune hemolytic anemia. Traditionally, splenectomy has been an open procedure; however, since the first laparoscopic splenectomy was reported in 1991, the minimally invasive laparoscopic approach has become increasingly popular. In most public hospitals in Brazil, where vessel sealing devices are not available, most surgeons seem to prefer open splenectomy to guarantee intraoperative safety and improved outcomes. Objectives: To compare outcomes between open and laparoscopic splenectomy in children in a public hospital in Brazil. Materials and Methods: Retrospective study conducted between January 2010 and June 2018. Patients from 0 to 14 years old who underwent open or laparoscopic splenectomy at the University Hospital of Federal University of Paraná were included. Clinical, laboratory, imaging, and surgical data were collected. Results: For 8 years, 35 patients underwent splenectomy. Mean age was 4 years old and 54% were female. Of the 35 subjects, 69% had sickle cell anemia and 23% spherocytosis. The most common indication for surgery was a previous episode of splenic sequestration. The 13 laparoscopic surgeries were performed without harmonic scalpel or other vessel sealing devices. During the laparoscopic procedure, 2 patients experienced intraoperative complications: bleeding and prolonged surgical time due to technical problems with the equipment. Mean operative time was higher in laparoscopy group than in open group (186 minutes versus 66 minutes). Oral feeds began earlier on the laparoscopic group. Postoperatively, there were more complications on the open group, and no reoperations. There was only one fatality, likely secondary to fulminant sepsis, which occurred 34 days after the surgery in a patient who was undergoing prophylactic oral antibiotics therapy. Discussion: Performing laparoscopic splenectomy without harmonic scalpel or other vessel sealing devices is feasible, but it implicates in a significantly higher surgical time. Laparoscopic splenectomy had earlier oral feeds and fewer complications than open surgery.