HPE refers to a spectrum of central nervous system (CNS) malformations that result from a primary defect in the normal inducing and molding of the rostral neural tube during early embryogenesis. It is usually considered to be the result of prosencephalon cleavage failure, which usually occurs during the fifth or sixth week of gestation (3,5). In 1882, Kundrat (6,7) reported the first description of neuropathological HPE, recognizing the aplasia of bulbs and olfactory tracts as a common denominator in this group of malformations, which he named arhinencephaly. In , after Yakovlev’s8 studies, the term arhinencephaly was considered erroneous. In 1963, DeMyer and Zeman,9followed by DeMyer et al.10 in 1964, named this malformation as presented with orbital hypotelorism, flat nose, bilateral cleft lip, and cleft palate. They believed holoprosencephaly, studying two patients who and Gross (1973) (12). introduced the concept of the defects of the midline (6,12,13). Based on the gross examination of the degree of non- hemispherical separation, DeMyer and Zeman (1963) (9). Also proposed a classification of HPE into three types, namely a lobar, semi lobar, and
through the ASD and atrioseptostomy was indicated. Femoral vein puncture and insertion of a 6F-pediatric sheath were performed at the Intervention Cardiology Laboratory under general anesthesia. Absence of the IVC hepatic segment and continuity of azygos vein into the superior vena cava was identified. Access via umbilical vein was not possible since it had already been used for insertion of a central venous catheter in the first days of hospitalization. Since this was a critically ill neonatewith low systemic arterial saturation and no clinical conditions for a surgical procedure at that moment, we decided to try the transhepatic puncture of the supra hepatic vein.
Congenital pyloric atresia is a rare anomaly accounting for less than 1% of upper GI atresias. It may occur in isolation or in association with other congenital anomalies, epidermolysis bullosa being the most frequent. It presents with upper abdominal distension, non-bilious vomiting or rarely with complications as aspiration pneumonia, electrolyte imbalance or gastric perforation. Though iatrogenic gastric perforations secondary to aggressive resuscitation with bag-mask ventilation and nasogastric intubation are the most frequent in newborns, neonatal gastric perforation due to congenital outlet obstruction have rarely been reported [1-5]. The clinical course of a newborn is worth sharing who presented with gastric perforation and had an underlying pyloric atresia that was missed.
In view of the rare occurrence of a stillborn fetus with hyperthyroidism, we felt that it would be of extreme importance to study the pathologic changes in a fetus born to a patient with Graves’ disease who was not treated in time to prevent the severity of the situation and the fatal outcome, and for which the immediate cause of death seems to have been heart failure due to volume overload, as shown by the macroscopic findings.
maintaining anaesthesia for this particular neonatewith mass protruding from the mouth and fear of losing the airway during tracheostomy , we opted for awake trial laryngoscopy and intubation. The difficult airway cart with all the emergency drugs were kept ready and the ENT surgeons were present as a standby. Inj. Atropine 0.1mg I.V. was given prior to laryngoscopy. Since there was very minimal working space a 1 size Miller blade was used instead of Macintosh blade. After retracting the left cheek laterally withthe Miller blade, the mass was found to occupy the entire oral cavity leaving behind space just enough to pass the endotracheal tube. With little external laryngeal pressure, the epiglottis and posterior half of the glottis could be visualised. A 3mm ID un-cuffed endotracheal tube with stylet was negotiated through the available space into the glottic opening. After confirmation of correct placement, the endotracheal tube was fixed on the left side of the oral cavity (Figure 2). Immediately after securing the airway, the baby became very comfortable and maintained 99% saturation even without oxygen.
Table 2 shows the growth rate (weight and size gain) of infants in the four evaluations, by gender, type of delivery and birth weight. The weight and size gain rate was higher in boys in all evaluations (p < 0.05) and there was a slowdown of weight- size gain as from the second month in both gen- ders. Only up to the first month, the weight gain rate (WGR1) of children born from cesarean sec- tion was lower (p = 0.022) and there was no dif- ference in the size gain rate. It was observed that the weight gain rate did not differentiate between children who were born underweight and over- weight. The mean size gain rate up to six months (SGR6) was higher among infants bornwith low weight (p = 0.035) and lower among those bornwith high birth weight (p = 0.006).
samples (160/195; 82.1%) were obtained from newborns, livebirths (145/195; 74.4%) or stillbirths (15/195; 7.7%), but the sample also included children of different ages (26/195; 13.3%), adults (3/195; 1.5%), four fetuses (4/195; 2.1%), and two (1.0%) of unknown ages. Females were predominant, with 112 females (58.6%) vs. 79 males (41.4%), and this predominance was significant when con- sidering the sex ratio expected at birth (c 2 = 7.10; P = 0.008; GL = 1). One patient had no information, and three patients were intersexes. There were 110 patients with isolated HPE or microform (“isolated cases”), and 85 patients (43.6%) with other malformations unrelated to the HPE spectrum (“associated cases”). The occurrence of HPE was verified through pre or postnatal brain imaging or autopsy in 155 probands (79.5%). Forty-one cases with specified HPE types presented with alobar HPE type (41/79; 51.9%), 29 cases presented with semilobar HPE type (29/79; 36.7%), and nine cases presented with lobar HPE type (9/79; 11.4%). In 97 probands HPE was not specified, although there was a suspicion of interhemispheric variant of HPE in three cases. Nineteen patients (19/195; 9.7%) had no HPE in cerebral imaging: one patient presented premaxillary agenesis and anophtalmia, two patients were obligated car- rier mothers, and 16 patients had SMMCI. Five of the 16 SMMCI patients exhibited a mild phenotype without men- tal deficiency and additional defects, such as microcephaly, choanal atresia, lacrimal conduct atresia, or ocular hypo- telorism.
A male infant wasborn ater 28 weeks of gestation with a birth weight of 910 grams and Apgar scores of 4 at the irst minute and 7 at the ith minute. At 2 days of age, still without bowel movements, he developed abdominal distension and vomiting. Abdominal radiog- raphy showed severe small-bowel distension and wall edema without pneumoperitoneum. Oral feeding was discontinued and antibiotics and total parenteral nutrition were started due to clinical suspicion of necrotizing enterocolitis. A barium enema revealed a state of microcolon due to disuse. On laparotomy, intestinal atresia in the terminal ileum and a disconnected cecum were identiied. Ileostomy and cecostomy were performed, and a set of biopsies was obtained, going from the transverse colon to the rectum. Histopathological examination revealed absence of ganglion cells in the rectum and sigmoid colon, consistent with Hirschsprung disease (Figure 1). A Duhamel procedure was performed, with total colectomy due to absence of ganglion cells throughout the colon, which was identiied during frozen section examination.
A male neonatewasborn in good clinical conditions, with normal fontanelles. His gestational age was calculat- ed as 34 weeks by the Capurro method. His head circum- ference was 29.0 cm, a point on the line corresponding to minus two standard deviations (–2 SD) of the population normal range. The other anthropometric measures were the following: 1.740 g of weight (between –1 SD and –2 SD); 40.5 cm of length (below –2 SD); 26.0 cm of thoracic circumference (on –1 SD). His Apgar score at the first minute was 4, and 7 at the fifth. His blood type was B+. The phys- ical examination revealed characteristic features of DS: oblique (upslanting) palpebral fissures; flat nasal bridge; open mouth; protruding tongue; transverse palmar creas- es; hypotonia; poor Moro reflex; hyperflexibility; short stature; loose skin on nape of neck; flat facial profile; epi- canthic folds; short broad hands; clinodactyly of fifth fin- ger; gap between the first and second toes. The chromo- somal analysis was undertaken and in a few days the full trisomy of chromosome 21 was confirmed. Echocardiogra- phy and screening for inborn errors of metabolism, both with normal results. He developed transient neonatal ta- chypnea and jaundice, reaching 13.7 mg/dL of total serum bilirubin (TB), mainly of indirect type (IB=13.0 mg/dL). Photo- therapy was accomplished and TB fell to 6.8 mg/dL in a few days (IB=6.2 mg/dL). Cranial ultrasonography and comput- ed tomography (CT scan) undertaken in the first week of life exhibited moderate increase of both lateral ventricles, especially in the posterior regions (occipital horns).
The first generation of internauts lived through their ado- lescence during the 1990s in the days of Internet 1.0. Instead, the second generation was weaned on Internet 2.0. By Internet 1.0 what is usually meant is the first decade of the Internet, the 1990s. In these years, the Net consisted of thousands of websites, mainly text-based. By Internet 2.0 is meant the second decade, the 2000s. As from these years, SNSs began to become accessible to all, until they became central to the lives of most internauts. At the same time, multimedia was developed and made economically accessible, which enabled millions of people to have access to a computer with an Internet connection, gaming consoles, smart mobile phones and digital cameras for the first time. Whereas the first generation of youths spent their adolescence with Internet 1.0, the second generation did so with Internet 2.0. Based on this argument, this paper describes the similarities and differences encountered between these two generations: the one of those born between 1980 and 1994, whom we call “digital natives 1.0” (hereafter, “DNs 1.0”), and the generation of those born between 1995 and 2000, whom we call “digital natives 2.0” (hereafter, “DNs 2.0”).
Objectives: This cross-sectional study was designed to examine the effects of the Valsalva Maneuver (VM) and its duration on the acid- base equilibrium of theneonate and its maternal repercussions during the expulsive stage of labor, after standard breathing and pushing instructions were given. Methods: A convenience sample of women with low risk pregnancy (n=33; mean age 22.5±3.7y and gestational age 38.1±1.12wks) and their newborns were studied during the expulsive stage of vaginal labor. Coaching consisted of standard recommendations for breathing including prolonged VMs coordinated with pushing. Maternal outcomes included the need for uterus fundal pressure maneuver and episiotomy, perineal trauma and posture. Neonatal outcomes included blood gases sampled from the umbilical cord, and Apgar scores. Data were analyzed withthe Fisher´s exact test, chi-square test, and Pearson correlation coefficient. Results: None of the maternal outcomes were associated with VM duration. With respect to neonatal outcomes, increased VM duration was associated with reduced venous umbilical pH (r=-0.40; p=0.020), venous base excess (r=-0.42; p=0.014) and with arterial base excess (r=-0.36; p=0.043). Expulsive stage time was negatively associated with umbilical venous and arterial pH. Conclusions: VM duration during fetal expulsion in labor negatively affects fetal acid-base equilibrium and potentially the wellbeing of theneonate. Our results support the need to consider respiratory strategies during labor, to minimize potential risk to the mother and neonate.
Consequently, the umbilical cord cutting experience may be viewed as overcoming an imaginary barrier, the physical separation of the child from the mother. Perhaps, this can represent a way for the father to approach and to be part of the family, which may allow him to feel included in the process, thus increasing his confidence in his ability to take care of his newborn. We consider this hypothesis as a potential explanation for the achieved results. Nonetheless, we recognize not the need for evidence indicating if this increase of emotional involvement between father and baby has long-term implications beyond the studied period. As it was not the focus of the work, it is regarded as relevant future work.
A 3.5-kilogram male infant was taken up for an elective left inguinal herniotomy at 6 weeks of age. The premature infant wasborn at 34 weeks of gestation by an emergency Caesar- ean Section due to intrauterine fetal distress. Following birth, he developed neonatal sepsis and was managed for ten days in the nursery. Since then the infant had an uneventful period and was subsequently cleared from a pre-anesthetic outpa- tient and pediatric clinics for an elective inguinal herniotomy at 40 weeks of post-conceptual age. In keeping withthe re- cent trends of preoperative investigation protocols, only a hemoglobin level 1 was done which reflected mild anemia
ABSTRACT: Introduction: Hypertension is a major public health problem due to its high prevalence, low levels of control, and cardiovascular morbidity and mortality. Objective: To analyze the prevalence of hypertension and associated factors in men and women living in the cities of Legal Amazonia. Methods: A population-based, cross-sectional study was carried out with 1,296 adults in the cities of Legal Amazonia. Socio-demographic, lifestyle, and anthropometric data were collected and blood pressure was measured, being considered hypertensive those individuals who had blood pressure ≥ 140/90 mmHg and/or those who reported the use of antihypertensive drugs. Statistical analyzes were performed using the survey module preix in Stata version 11.0. Results: The prevalence of hypertension was 22.3%. After adjusting, the variables associated with hypertension in men were in the age groups 30 – 39 years (adjusted prevalence ratio [PR] = 2.69; 95%CI 1.49 – 4.86), 40 – 49 years (adjusted PR = 3.28; 95%CI 1.82 – 5.93), and 50 – 59 years (adjusted PR = 4.80; 95%CI 2.63 – 8.76); overweight (adjusted PR = 1.97; 95%CI 1.39 – 2.78); obesity (adjusted PR = 3.32; 95%CI 2.32 – 4.75); and being born in the North or Northeast regions (adjusted PR = 0.31; 95%CI 0.18 – 0.59). Among women, the age groups 40 – 49 years (adjusted PR = 3.41; 95%CI 1.91 – 6.07) and 50 – 59 years (adjusted PR = 7.29; 95%CI 4.07 – 13.07), wine consumption (adjusted PR = 0.31; 95%CI 0.10 – 0.97), and obesity (adjusted PR = 2.39; 95%CI 1.65 – 3.45) were associated with hypertension. Conclusion: In men, hypertension was independently associated with age, nutritional status, and place of birth, whereas in women, the variables associated with hypertension were age, nutritional status, and type of alcoholic beverage.
We included 77 patients with 99 AO foci. The mean age was 21 (range: 2-53) days, 42 patients (55%) were male. Mean gestational age at birth was 38 (range: 26- 42) weeks. Of all patients, 49 (64%) had nosocomial in- fections, and at least one risk factor for infection was present in 53 (69%) patients: high-risk pregnancy in 19 (25%), prematurity in 15 (20%), birth weight less than 1500 g in 5 (7%), asphyxia in 16 (21%), central catheter- ization in 24 (31%), mechanical ventilation in 11 (14%), and previous antibiotics in 35 (45%). Less than 4% of patients had a history of surgery, necrotizing enterocoli- tis or steroid medication (Table 1).
O bjectives: The aim of this study was to evaluate the prevalence of enamel defects and their risk factors on primary and permanent dentitions of prematurely born children and full-term born children born at Regional Hospital of Asa Sul, Brasília, DF, Brazil. Material and Methods: eighty 5-10-year-old children of both genders were examined, being 40 born prematurely (G1) and 40 born full term (G2). The demographic variables, medical history and oral health behaviors were retrieved using a questionnaire and data obtained from clinical examination were recorded. The teeth were examined and the presence of enamel defects was diagnosed according to the DDe Index and registered in odontograms. Subsequently, the defects were categorized in four groups according to one of the criteria proposed in 1992 by the FDI Commission on Oral Health, Research and Epidemiology. Kruskal-Wallis, Chi-square, Kappa, Mann-Whitney tests and logistic regression were used for statistical analysis. Results: 75% of total sample had enamel defects. There was a major prevalence of hypoplasia of the enamel in G1 (p<0.001). There was a signiicant relationship between low weight and presence of the imperfections on the enamel in G1 on the primary dentition. The logistic regression model showed that the other risk factors such as monthly per capita family income, educational level, dietary and hygiene habits, luoride exposure, trauma, and diseases were not associated with enamel defects and caries. Conclusions: Pre-term labor can be a predisposing factor for the presence of the enamel hypoplasia in the primary dentition.
The difference in self-reported health status in sero- negative was signiicant in individuals born after, with a higher proportion of seropositivity in those who reported their health to be good or very good (Table 1). No association was observed between self-perceived health status and rubella immunization either overall (OR 1.6; 95%CI 0.93;2.8) nor disaggregated by birth-year cohort (born before: OR 1.12; 95%CI 0.61;2.5; born after: OR 3.6; 95%CI 0.68;19.2). Signiicant differences were found in education level, with a higher seropositivity in those who had attained a higher level, compared with those who had not (Table 1). An potential association was observed between education levels and immunization status in those born before (OR 0.14; 95%CI 0.06;0.34) but not in those born after nor overall (born after: OR 1.8; 95%CI 0.4;8.2; overall: OR 1.2; 95%CI 0.8;2.0).
Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare autosomal recessive disorder that was first described in 1976 by Berdon et al., in five newborn girls . It is characterized by abdominal distension, distended non- obstructive urinary bladder, microcolon, intestinal hypoperistalsis and malrotation of the small intestine. This entity was originally described as a pathology almost exclu- sively confined to females. Prune Belly Syndrome (PBS) on the other hand was classically a male entity, withthe triad of a lax abdominal wall, bilateral cryptorchidism, and a dilated, dysmorphic urinary tract. We present an extremely rare as- sociation of a male neonate presenting to us with all the above criteria of MMIHS in addition to the classical triad of PBS and review the literature regarding the pathogenesis.
ANESTHETIC MANAGEMENT: Intraoperative monitoring was done with ECG, Pulse oxymetry, Neonatal NIBP. Baby was preoxygenated with 100% oxygen. Premedication was given with IV Glycopyrrolate, ondansetron 300µg and Fentanyl 3µg. Induced with 3% Sevoflurane. Laryngoscopy and Magills assisted nasal intubation tried but could not be accomplished due to narrow space in the oral cavity.