RESUMO
INTRODUCTION: Pulmonary hypertension (PH) is an important contributor to morbidity and mortality in patients seeking emergency care, resulting in high acuity presentations and resource utilization. The objective was to characterize the rate of intensive care unit (ICU) admission for PH among adult patients presenting to the emergency department (ED) along with other important clinical outcomes. METHODS: We analyzed data from the State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) from two geographically separated U.S. states (New York and Nebraska). The primary outcome measure was admission to an ICU. Other measures of interest included the hospital admission rate, hospital length of stay (LOS), inpatient mortality, and rate of critical care procedures performed. RESULTS: From 2010 to 2014, in a sample of 34 million ED visits, patients with a diagnosis of PH accounted for 0.71% of all ED visits. Of the PH visits, 20.2% were admitted to the ICU, compared to 2.6% of all other visits (P < 0.001), with an aOR of 1.74 (95% CI 1. 72-1.76). The vast majority (94.6%) of PH patients were admitted to the hospital, compared to 20.5% for all other ED visits (P < 0.001). Hospital LOS and hospital-based mortality were higher in the PH group than for other ED patients. With the exception of invasive mechanical ventilation, a significantly higher percentage of patients with PH admitted to the ICU than other patients underwent all critical care procedures evaluated. CONCLUSIONS: In this study, patients with PH who sought emergency care in U.S. EDs from 2010 to 2014 were significantly more likely to require ICU admission than all other patients. They were also significantly more likely to be admitted to the hospital than all other patients, had longer hospital LOS, increased risk of inpatient mortality, and underwent more critical care procedures. These findings indicate the high acuity of PH patients seeking emergency care and demonstrate the need for additional research into this population.
Assuntos
Serviço Hospitalar de Emergência , Hospitalização/estatística & dados numéricos , Hipertensão Pulmonar/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão Pulmonar/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nebraska/epidemiologia , New York/epidemiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Children living with sputum smear-positive adult tuberculosis (TB) patients are vulnerable to acquire tubercular infection. Contact tracing is an important strategy to control tubercular infection in the community. This study was done to find out prevalence of tuberculosis and tubercular infection in children living with sputum smear-positive adult patients receiving DOTS at recruitment and to find out incidence of tubercular infection and disease in these children on follow up. METHOD: Children (< 15 years) living in contact with adults on DOTS were grouped as < 6 years and 6-14 years. They were further sub grouped as being - uninfected, infected, diseased and on prophylaxis and were followed at 3, 6 and 9 months. Tuberculin skin test (TST) and chest X-ray were done. RESULTS: At recruitment 152 children were enrolled and 21.1% (n = 32) had TB. On follow up, 4.3% (n = 5), 5.8% (n = 6) and 11.6% (n = 11) children developed TB after 3, 6 and 9 months respectively.9 children did not come for the last follow up so the overall prevalence of TB disease at 9 months was 37.7% (n = 54). Out of the 128 children with TST reading 23.4% (n = 30) child contacts were found to be infected already at recruitment. The incidence of TST conversion was 20.7% (n = 18), 26.9% (n = 18) and 16.3% (n = 7) respectively. The overall prevalence of tubercular infection in the children, who were in contact with TB patients for 9 months was 74.5% (n = 73). CONCLUSION: About half the children were either suffering from TB or tubercular infection on recruitment. During 9 months follow up 22 unaffected children developed disease and 43acquired infection.
Assuntos
Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Características da Família , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Escarro/microbiologia , Teste Tuberculínico , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adulto JovemRESUMO
BACKGROUND: There is a lack of definite consensus on indications for initiating antibiotics in neonates with meconium aspiration syndrome (MAS), instigating researchers to search for a biomarker that can help differentiate MAS from MAS with bacterial infection. OBJECTIVE: Our primary objective was to compare serum procalcitonin (PCT) levels in full-term vigorous neonates having MAS with or without bacterial infection. MATERIALS AND METHODS: Seventy term vigorous neonates with diagnosis of MAS were enrolled. Blood samples were taken for sepsis screen, C-reactive protein (CRP), PCT, and blood culture at 6 ± 2 hours of respiratory distress. Neonates were categorized into group 1 (MAS without bacterial infection) and group 2 (MAS with bacterial infection) based on blood culture. The duration of our study was 18 months. RESULTS: Mean ± standard deviation PCT level was 2.52 ± 3.99 in group 1 and 2.71 ± 4.22 in group 2, which was comparable. At cutoff of 0.1 ng/mL, PCT had a sensitivity of 90% and specificity of 8% in detecting bacterial infection. Mean total leukocyte count, absolute neutrophil count, immature to total leucocyte ratio, microerythrocyte sedimentation rate, and CRP were comparable. CONCLUSION: Though PCT is an early and reliable marker of neonatal infection, the levels were increased in neonates with MAS irrespective of the presence of bacterial infection.
Assuntos
Infecções Bacterianas/diagnóstico , Síndrome de Aspiração de Mecônio/microbiologia , Pró-Calcitonina/sangue , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Feminino , Humanos , Recém-Nascido , Contagem de Leucócitos , Masculino , Síndrome de Aspiração de Mecônio/sangue , Neutrófilos/citologia , Curva ROC , Sensibilidade e EspecificidadeRESUMO
Acoustophoresis, the ability to acoustically manipulate particles and cells inside a microfluidic channel, is a critical enabling technology for cell-sorting applications. However, one of the major impediments for routine use of acoustophoresis at clinical laboratory has been the reliance on the inherent physical properties of cells for separation. Here, we present a microfluidic-based microBubble-Activated Acoustic Cell Sorting (BAACS) method that rely on the specific binding of target cells to microbubbles conjugated with specific antibodies on their surface for continuous cell separation using ultrasonic standing wave. In acoustophoresis, cells being positive acoustic contrast particles migrate to pressure nodes. On the contrary, air-filled polymer-shelled microbubbles being strong negative acoustic contrast particles migrate to pressure antinodes and can be used to selectively migrate target cells. As a proof of principle, we demonstrate the separation of cancer cell line in a suspension with better than 75% efficiency. Moreover, 100% of the microbubble-cell conjugates migrated to the anti-node. Hence a better upstream affinity-capture has the potential to provide higher sorting efficiency. The BAACS technique expands the acoustic cell manipulation possibilities and offers cell-sorting solutions suited for applications at point of care.
Assuntos
Acústica , Separação Celular/instrumentação , Dispositivos Lab-On-A-Chip , Microbolhas , Desenho de EquipamentoRESUMO
The reduction of Aflatoxin B1 (AF) in juvenile rainbow trout (Oncorhynchus mykiss) diet was analyzed after supplementing Nanostructured Zeolite (NZ) in a 56-day experiment. Two hundred and seventy juveniles with an average weight of 23 ± 3.7 g were placed in 6 different groups of C (control as a basal diet), NZ0.5 (basal diet + 0.5% NZ), NZ1 (basal diet + 1% NZ), AF5 (basal diet + 5 mg AFB1), AF5 NZ0.5 (basal diet + 5 mg AFB1 + 0.5% NZ), AF5 NZ1 (basal diet + 5 mg AFB1 + 1% NZ) with three replications and were fed four times a day based on their satiation. No significant differences were observed in terms of growth performance among the experimental groups (P > 0.05). However, hepatosomatic index in fish fed by AF5 NZ0.5 was reduced compared with NZ0.5 group (P < 0.05). The carcass moisture content showed a higher amount in treatment AF5 NZ0.5 compared to the control group (P < 0.05). There was a decrease in fat content in treatment AF5 compared to that of the control group (P < 0.05). Serum total protein, albumin and globulin levels in fish fed with aflatoxin were lower than in fish fed the diet without AF for all levels of NZ (P < 0.05); however, the interaction between AF and NZ was not significant (P > 0.05). Concentrations of C3, C4 and immunoglobulin M together with serum lysozyme activity showed no significant differences among all treatments (P > 0.05). No considerable histopathological lesions were observed in liver, kidney and spleen for all treatments. Based on the results, NZ showed some effects on physiological functions in juvenile rainbow trout fed by 0.5% dietary NZ which could improve performance in this species.
Assuntos
Aflatoxina B1/efeitos adversos , Composição Corporal , Imunidade Inata , Nanoestruturas/administração & dosagem , Oncorhynchus mykiss/imunologia , Substâncias Protetoras/farmacologia , Zeolitas/farmacologia , Ração Animal/análise , Animais , Composição Corporal/efeitos dos fármacos , Dieta/veterinária , Suplementos Nutricionais/análise , Imunidade Inata/efeitos dos fármacos , Oncorhynchus mykiss/crescimento & desenvolvimento , Substâncias Protetoras/administração & dosagem , Distribuição Aleatória , Zeolitas/administração & dosagemRESUMO
OBJECTIVE: The aim of the present study was to evaluate whether the order of complementary feeding in relation to breast-feeding affects breast milk, semisolid, or total energy intake in infants. METHODS: The present study was designed as a randomized crossover trial. The study was conducted in a tertiary care hospital. The study participants were 25 healthy infants between the ages of 7 and 11 months who were exclusively breast-fed for at least 6 months and were now receiving complementary foods for at least 1 month in addition to breast-feeding. Infants were randomized to follow a sequence of either complementary feeding before breast-feeding (sequence A) or complementary feeding after breast-feeding (sequence B) for the first day (24 hours) of the study period using simple randomization. For the next day, the sequence was reversed for each child. All babies received 3 actively fed complementary food meals per day (morning, afternoon, and evening). A semisolid study diet was prepared in the hospital by cooking rice and pulse with oil using a standard method, ensuring the energy density of at least 0.6 kcal/g. The infants were allowed ad libitum breast-feeding during the observation period. Semisolid intake was directly measured and breast milk intake was quantified by test weighing method. Energy intake from complementary foods was calculated from the product of energy density of the diet served on that day and the total amount consumed. The total energy intake and energy intake from breast milk and complementary foods between the 2 sequences were compared. RESULTS: The mean (standard deviation) energy intake from breast milk during 12 hours of daytime by following sequence A (complementary feeding before breast-feeding) was 132.0 (67.4) kcal in comparison with 135.9 (56.2) kcal in sequence B, which was not statistically different (Pâ=â0.83). The mean (standard deviation) energy consumed from semisolids in sequences A and B was also comparable (88.6 [75.5] kcal vs. 85.5 [89.7] kcal; P = 0.58). The total energy intake during daytime in sequence A was 220.6 (96.2) kcal in comparison with 221.5 (94.0) kcal in sequence B, which was also comparable (Pâ=â0.97). The results related to energy intake through breast milk and total energy intake were not different when insensible losses during feeding were adjusted in both groups. CONCLUSIONS: Altering the sequence of complementary feeding in relation to breast-feeding does not affect total energy intake.
Assuntos
Aleitamento Materno , Ingestão de Energia , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Refeições , Leite Humano , Estudos Cross-Over , Fabaceae , Feminino , Humanos , Lactente , Masculino , Valor Nutritivo , Oryza , DesmameRESUMO
Tuberculosis (TB) is a global disease with increase in concern with growing morbidity and mortality after drug resistance and co-infection with HIV. Mother to neonatal transmission of disease is well known. Current recommendations regarding management of newborns of mothers with tuberculosis are variable in different countries and have large gaps in the knowledge and practices. We compare and summarize here current recommendations on management of infants born to mothers with tuberculosis. Congenital tuberculosis is diagnosed by Cantwell criteria and treatment includes three or four anti-tubercular drug regimen. Prophylaxis with isoniazid (3-6 months) is recommended in neonates born to mother with TB who are infectious. Breastfeeding should be continued in these neonates and isolation is recommended only till mother is infectious, has multidrug resistant tuberculosis or non adherent to treatment. BCG vaccine is recommended at birth or after completion of prophylaxis (3-6 months) in all neonates.
Assuntos
Antibioticoprofilaxia , Antituberculosos/uso terapêutico , Vacina BCG/uso terapêutico , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Isoniazida/uso terapêutico , Tuberculose/congênito , Tuberculose/transmissão , Adulto , Feminino , Humanos , Recém-Nascido , Tuberculose/prevenção & controleRESUMO
PURPOSE: Birth asphyxia leading to acidosis comprises 20-60 % of perinatal mortality. Nuchal cord (NC) is one of the possible causes of birth asphyxia. Majority of fetuses who are antenatally detected to have nuchal cord are able to achieve successful vaginal birth. The purpose of this study was to analyze the effect of nuchal cord on fetal acid base status and perinatal outcome in vaginal deliveries. STUDY DESIGN: 150 parturients were equally divided into three groups after vaginal delivery based on no NC, single and multiple loops. Umbilical cord arterial blood was analyzed for biochemical markers i.e. pH, PO2, SPO2, PCO2, HCO3 (-), standard base excess and lactate for acidosis. Labor complications like abnormal FHR, meconium-stained liquor, prolonged second stage, instrumental vaginal delivery, third stage complications were compared. In neonates, birth weight, Apgar score ≤7 at 5 min, NICU admission and other morbidity and mortality during hospital stay were compared among groups using suitable statistical tests. Above parameters were also compared between tight and loose loops. RESULT: Nuchal cord groups had significantly higher frequency of labor complications than no NC group, especially tight loops. Neonates with NC had significantly higher frequency of meconium-stained liquor, Apgar score ≤7 at 5 min, deranged biochemical markers, NICU transfer. However, none of the neonate had pH in acidosis range and majority were discharged in healthy condition. CONCLUSION: Patients with NC are likely to have uneventful labor and delivery as cord compression is transient and most fetuses are able to compensate for reduce umbilical blood flow. Routine antenatal ultrasound scan is not advisable, as mode of delivery and labor management does not change with detection of NC antenatally. Therefore, vaginal delivery with routine labor protocol can be allowed in cases of nuchal cord.
Assuntos
Parto Obstétrico , Sangue Fetal/química , Cordão Nucal/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Obstetrícia , Adulto , Índice de Apgar , Dióxido de Carbono/sangue , Estudos Transversais , Feminino , Frequência Cardíaca Fetal , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Segunda Fase do Trabalho de Parto , Ácido Láctico/sangue , Masculino , Mecônio , Cordão Nucal/psicologia , Oxigênio/sangue , Gravidez , Bicarbonato de Sódio/sangueRESUMO
OBJECTIVE: To compare the proportion of exclusively breastfed (EBF) infants having severe vitamin D deficiency (25(OH)D concentration <11 ng/mL) at 6 months of age when mothers were supplemented with 300,000 IU vitamin D3 or placebo during the third trimester of pregnancy. METHODS: In this randomized double-blind placebo-controlled trial, we recruited 100 pregnant women (who were willing to exclu-sively breastfeed their babies for 6 months) at 30-32 weeks gestation and the infants born to them. Pregnant women were randomized to receive either oral vitamin D3 60,000 IU or placebo, given weekly for 5 weeks during the third trimester. Serum 25(OH)D, calcium, phosphorus and alkaline phosphatase concentration were measured in all participants at recruitment, in the cord blood at delivery, and in infants at 6 months of age. The proportion of infants developing severe vitamin D deficiency and rickets at 6 months was assessed. RESULTS: A total 72 mother-infant dyads were followed-up till 6 months. At enrollment, the mean (SD) serum 25(OH)D concentration (ng/mL) were comparable in mothers in the intervention and control groups [12.9 (5.8) vs 12.8 (5.9), P = 0.96]. The mean (SD) 25(OH)D concentration (ng/mL) in the cord blood was significantly higher in the intervention group compared to the control group [42.1 (17.1) vs 12.7 (6.3); P = 0.002]. Serum 25(OH)D levels (ng/mL) in the infants at 6 months age were higher in the intervention group compared to the control group [31.8 (10.9) vs 12.5 (5.7); P < 0.001]. No infant in the intervention group had severe vitamin D deficiency at 6 months age compared to 54.3% infants in the control group (P < 0.001). No infant in the intervention group developed rickets. CONCLUSION: Oral supplementation of vitamin D3 to pregnant women in the third trimester prevents severe hypovitaminosis D in the EBF infants at 6 months of age.
Assuntos
Aleitamento Materno , Suplementos Nutricionais , Deficiência de Vitamina D , Vitamina D , Humanos , Feminino , Método Duplo-Cego , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/prevenção & controle , Lactente , Gravidez , Vitamina D/sangue , Vitamina D/análogos & derivados , Vitamina D/administração & dosagem , Aleitamento Materno/estatística & dados numéricos , Adulto , Recém-Nascido , Colecalciferol/administração & dosagem , Cuidado Pré-Natal/métodosRESUMO
Prematurity is a significant contributor to neonatal mortality in India. Conventionally, assessment of gestational age of newborns is based on New Ballard Technique, for which a paediatric specialist is needed. Anthropometry of the newborn, especially birthweight, has been used in the past to predict the gestational age of the neonate in peripheral health facilities where a trained paediatrician is often not available. We aimed to determine if neonatal anthropometric parameters, viz. birthweight, crown heel-length, head-circumference, mid-upper arm-circumference, lower segment-length, foot-length, umbilical nipple distance, calf-circumference, intermammary distance, and hand-length, can reliably predict the gestational age. The study also aimed to derive an equation for the same. We also assessed if these neonatal anthropometric parameters had a better prediction of gestational age when used in combination compared to individual parameters. We evaluated 1,000 newborns in a cross-sectional study conducted in Guru Teg Bahadur Hospital in Delhi. Detailed anthropometric estimation of the neonates was done within 48 hours after birth, using standard techniques. Gestational age was estimated using New Ballard Scoring. Out of 1,250 consecutive neonates, 1,000 were included in the study. Of them, 800 randomly-selected newborns were used in devising the model, and the remaining 200 newborns were used in validating the final model. Quadratic regression analysis using stepwise selection was used in building the predictive model. Birthweight (R=0.72), head-circumference (R = 0.60), and mid-upper arm-circumference (R = 0.67) were found highly correlated with gestation. The final equation to assess gestational age was as follows: Gestational age (weeks) = 5.437 x W-0.781 x W(2) + 2.815 x HC-0.041 x HC(2) + 0.285 x MUAC-22.745 where W=Weight, HC=Head-circumference and MUAC=Mid-upper arm-circumference; Adjusted R = 0.76. On validation, the predictability of this equation is 46% (+/-1 week), 75.5% (+/- 2 weeks), and 91.5% (+/- 3 weeks). This mathematical model may be used in identifying preterm neonates.
Assuntos
Antropometria/métodos , Idade Gestacional , Recém-Nascido Prematuro/fisiologia , Peso ao Nascer/fisiologia , Estudos Transversais , Feminino , Humanos , Índia , Recém-Nascido , Masculino , Reprodutibilidade dos TestesRESUMO
Presence of blood in the breastmilk renders a rusty or brownish colour to it; this entity is known as "rusty pipe syndrome". Although this is a self-limiting condition, it can be particularly intimidating for mothers and may act as a psychological barrier to successful breastfeeding. We describe this entity in two mothers who had spontaneous blood-stained breastmilk from both breasts in the early post-partum period and were worried about feeding their infants. Subsequent to proper counselling with the use of skills like active listening, accepting their concerns, building confidence by providing relevant information in simple language and by giving suggestions and avoiding commands, both mothers were able to successfully breastfeed their offspring.
Assuntos
Aleitamento Materno/psicologia , Aconselhamento/métodos , Transtornos da Lactação/sangue , Transtornos da Lactação/psicologia , Leite Humano , Relações Mãe-Filho , Mães/educação , Período Pós-Parto/fisiologia , Adulto , Ansiedade/prevenção & controle , Feminino , Humanos , Recém-Nascido , Mães/psicologia , Síndrome , Adulto JovemRESUMO
A descriptive study was conducted with an objective to determine the predictors of mortality among referred neonates and to ascertain their transport characteristics. A total of 300 consecutive neonates who were transferred to the centre were enrolled in the study. Following information were recorded: maternal details, birth details, interventions before transportation, details of transportation and neonatal condition at arrival. Detailed clinical assessment and management was done as per standard neonatal protocols. Birth weight <1 kg (OR 0.04; 95% CI: 0.006-0.295, P<0.01) and transportation time >1 hour (OR 5.58; 95% CI: 1.41-22.01, P=0.01) were found to be significant predictors for mortality among the transported neonate. Transport characteristics reflect road transport with limited utility of ambulances and lack of trained health personal. Hence to conclude, extreme low birth weight and prolonged transportation time were found to be significant predictors of neonatal mortality among the transported neonate.
Assuntos
Mortalidade Infantil , Encaminhamento e Consulta/estatística & dados numéricos , Peso ao Nascer , Feminino , Idade Gestacional , Nível de Saúde , Humanos , Índia/epidemiologia , Recém-Nascido , Masculino , Prognóstico , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricosRESUMO
BACKGROUND: Cholestatic jaundice and liver enzyme abnormalities have been reported in neonatal septicaemia; the course, pattern, and outcome of such hepatobiliary dysfunction have not been described. METHODS: One hundred fifty-three neonates with blood culture-positive sepsis were recruited from the neonatal intensive care unit of an urban hospital. Liver function tests were done on day 3 and day 10 in all of the cases. In babies with abnormal results (direct bilirubin >20% of total with a minimum level of 2/dL or alanine aminotransferase [ALT] >50 âU/L), tests were repeated weekly for 1 month and then fortnightly for 3 months or until normalization of values. Anthropometry was recorded at all of these visits. RESULTS: Klebsiella pneumoniae was the commonest organism, isolated in 95.4% of subjects. Eighty-three (54.2%) subjects had hepatobiliary dysfunction in the form of either cholestatic jaundice (nâ=â65 [42.5%]) or derangement in ALT (nâ=â57 [37.3%]). The onset of cholestasis was seen by day 3 of sepsis in 80% (nâ=â52), with maximum value of direct bilirubin seen by the 10th day in 90% (nâ=â58). Only 15% (nâ=â10) continued to have cholestatic jaundice beyond 30 days of onset of sepsis, and it resolved by 60 days. Hepatic enzyme abnormalities followed a more protracted course: onset by day 10 in 95%, peak value by day 38 in 90%, and normalisation by 60 days in 82% of subjects. The prevalence of any hepatobiliary dysfunction was found less frequently in babies who died as compared with survivors (43.4% vs 56.7%; Pâ<â0.01). The weight, length, and head circumference during follow-up visits were comparable between neonates with or without hepatobiliary dysfunction. CONCLUSIONS: Hepatobiliary dysfunction is common in Gram-negative neonatal septicaemia. The onset of abnormalities is early in most cases but ultimately resolve within 2 to 3 months after sepsis. The presence of conjugated hyperbilirubinemia in neonatal sepsis may carry a better prognosis in terms of survival and has no significant effect on growth during early infancy.
Assuntos
Bacteriemia/complicações , Colestase/microbiologia , Icterícia Obstrutiva/microbiologia , Infecções por Klebsiella/complicações , Alanina Transaminase/sangue , Bacteriemia/sangue , Bacteriemia/mortalidade , Biomarcadores/sangue , Colestase/sangue , Colestase/epidemiologia , Colestase/mortalidade , Seguimentos , Humanos , Recém-Nascido , Icterícia Obstrutiva/sangue , Icterícia Obstrutiva/epidemiologia , Icterícia Obstrutiva/mortalidade , Infecções por Klebsiella/sangue , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae/isolamento & purificação , Testes de Função Hepática , Prevalência , Prognóstico , Estudos ProspectivosRESUMO
Stippled cartilaginous calcification, an important radiologic sign, is described as ''chondrodysplasia punctata'' when seen in association with limb shortening and maxillofacial hypoplasia. We report chondrodysplasia punctata in a male neonate who presented with limb shortening, midfacial hypoplasia, and laryngeal stenosis leading to death within a few minutes of birth. A post-mortem radiograph revealed generalized punctate calcification of cartilaginous structures, including airways, rib ends, spine, long bone epiphyses, tarsus and pinna, and brachytelephalangy.
Assuntos
Condrodisplasia Punctata/patologia , Pulmão/anormalidades , Evolução Fatal , Humanos , Recém-Nascido , MasculinoRESUMO
Introduction. Pott's puffy tumor is characterized by the osteomyelitis of the frontal bone with underlying subperiosteal abscess, mostly occurring secondary to recurrent sinusitis or head trauma. Though it is a rare clinical entity in this antibiotic era, its occurrence mostly in the adolescent age group has now shown increased reporting lately in all age groups. Case Description. We describe here a case of a 4½-month-old female baby who presented to our hospital's Emergency Room with clinical features of pyogenic meningitis following aspiration of a midline frontal swelling. The infant presented with high-grade fever, 3-4 episodes of projectile vomiting, increased irritability, and refusal to breastfeeding than usual. This was accompanied by a history of a gradually increasing midline fluctuant erythematous swelling on her forehead extending to the left eye. Aspiration of the swelling was done a day before by a local general practitioner, following which she developed the above-mentioned features of pyogenic meningitis and was brought to the hospital the next day. Examination revealed a conscious, febrile, irritable child with bulging anterior fontanel and 101.4°F axillary temperature. Vital signs were within normal limits. CSF analysis was suggestive of pyogenic meningitis, and appropriate antibiotics were given. MRI showed frontal bone osteomyelitis with erosion of the bony plate and focal cerebritis. The condition turned out to be Pott's puffy tumor with pyogenic meningitis after detailed investigations. The infant was treated with appropriate antibiotics and other supportive therapeutic measures and discharged with the advice for further management in collaboration with otorhinolaryngologist.
RESUMO
Intra-abdominal calcification is uncommon in newborns and has several causes of which meconium peritonitis is the most frequent. Three neonates with intra-abdominal calcification as a complication of meconium peritonitis are presented. The types of meconium peritonitis were cystic, meconium pseudocyst and meconium ascites. Two required surgical intervention. Meconium peritonitis should be considered in newborns with intra-abdominal calcification.
Assuntos
Calcinose/diagnóstico , Mecônio/diagnóstico por imagem , Peritonite/complicações , Peritonite/diagnóstico , Adulto , Calcinose/etiologia , Calcinose/patologia , Feminino , Humanos , Recém-Nascido , Masculino , Peritonite/etiologia , Peritonite/patologia , Radiografia Abdominal , UltrassonografiaRESUMO
OBJECTIVES: (i) To measure 25-OH vitamin D levels in term infants at 10 weeks and 6 months and to correlate with maternal vitamin D levels at 10-week postpartum (ii) To evaluate infants at 6 months for rickets. PATIENTS AND METHODS: A total of 179 exclusively breastfed infant-mother pairs 96 appropriate-for-gestational age (Group 1) and 83 small- for- gestational age infants (Group 2) recruited at 10 weeks. At 6 months, 52 in group 1 and 45 in group 2 were evaluated. Venous blood sample were collected at 10 weeks and 6 months in infants and at 10 weeks in mothers for calcium, phosphorus, alkaline phosphatase and 25-OH vitamin D estimation. RESULTS: Mean 25-OH vitamin D levels of infants (n = 97) were 11.55 ± 7.17 ng/mL at 10 weeks and 16.96 ± 13.33 ng/mL at 6 months (p < 0.001). Mean vitamin D levels of infants in group 1 and group 2 did not differ at recruitment and 6 months (p > 0.05)). Maternal vitamin D levels in group 1 and group 2 were 8.89 ± 5.97 and 9.87 ± 6.44 ng/mL, respectively (p = 0.44). Significant correlation was observed between 25-OH vitamin D of infants and mothers (p < 0.05). At 10 weeks, 55.67% infants, 70% mothers and at 6 months, 44.33% infants had vitamin D < 11 ng/mL. At 6 months, 16.49% infants developed rickets. CONCLUSIONS: Exclusively breastfed infants and their mothers are Vitamin D deficient, hence the need to improve vitamin D status.
Assuntos
Aleitamento Materno , Período Pós-Parto/sangue , Nascimento a Termo , Deficiência de Vitamina D/diagnóstico , Vitamina D/sangue , Fosfatase Alcalina/sangue , Cálcio/sangue , Feminino , Seguimentos , Humanos , Índia , Lactente , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Mães , Fósforo/sangue , Estudos ProspectivosRESUMO
Folic acid supplementation is important in the prevention of Neural Tube Defects (NTD). The study was conducted to assess the awareness amongst physicians regarding the role of Folic Acid (FA) in the prevention of NTD. Physicians were interviewed regarding the awareness of FA dose, timing of supplementation and knowledge about its role in prevention of neural tube defects using a semistructured questionnaire. Among 202 physicians interviewed (48 pediatricians, 54 obstetricians, 100 recently qualified medical graduates) overall awareness about FA was present in 92.07%, similar in three groups (P > 0.05). Only 47.52% were aware of preconception administration, 61.38% about dose of supplementation and 11.88% about recurrence rate of NTD. Only 15 (7.4%) knew all these. Regarding the etiology of NTDs only 26.7% said both FA and genetic factors are involved. Though majority were aware that folic acid has a role in prevention of NTDs, their knowledge about timing and dose of supplementation was lacking. Hence attempts should be made to increase the awareness regarding prevention of NTD's by FA supplementation at a proper time.
Assuntos
Ácido Fólico/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Defeitos do Tubo Neural/prevenção & controle , Médicos/estatística & dados numéricos , Suplementos Nutricionais/normas , Feminino , Alimentos Fortificados/normas , Humanos , Índia , Obstetrícia , Pediatria , Cuidado Pré-Concepcional/normas , Cuidado Pré-Concepcional/estatística & dados numéricos , Gravidez , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Pulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality. Our objective was to characterize the prevalence of PH among adult patients presenting to United States (US) emergency departments (ED) and to identify demographic patterns and outcomes of PH patients in the ED. METHODS: We analyzed the Nationwide Emergency Department Sample (NEDS) database, with a focus on ED patients aged 18 years and older, with any International Classification of Diseases, Clinical Modification (ICD)-9-CM or ICD-10-CM diagnosis code for PH from 2011 to 2015. The primary outcome was inpatient, all-cause mortality. The secondary outcomes were hospital admission rates and hospital length of stay (LOS). RESULTS: From 2011 to 2015, in a sample of 121,503,743 ED visits, representing a weighted estimate of 545,500,486 US ED visits, patients with a diagnosis of PH accounted for 0.78% (95% confidence interval [CI], 0.75-0.80%) of all US ED visits. Of the PH visits, 86.9% were admitted to the hospital, compared to 16.3% for all other ED visits (P <0.001). Likewise, hospital LOS and hospital-based mortality were higher in the PH group than for other ED patients (e.g., inpatient mortality 4.5% vs 2.6%, P < 0.001) with an adjusted odds ratio (aOR) of 1.34 (95% CI, 1.31-1.37). Age had the strongest association with mortality, with an aOR of 10.6 for PH patients over 80 years (95% CI, 10.06-11.22), compared to a reference of ages 18 to 30 years. CONCLUSION: In this nationally representative sample, presentations by patients with PH were relatively common, accounting for nearly 0.8% of US ED visits. Patients with PH were significantly more likely to be admitted to the hospital than all other patients, had longer hospital LOS, and increased risk of inpatient mortality.