Neonate Human Remains: A Window of Opportunity to the Molecular Study of Ancient Syphilis

Ancient DNA (aDNA) analysis can be a useful tool in bacterial disease diagnosis in human remains. However, while the recovery of Mycobacterium spp. has been widely successful, several authors report unsuccessful results regarding ancient treponemal DNA, casting doubts on the usefulness of this technique for the diagnosis of ancient syphilis. Here, we present results from an analysis of four newborn specimens recovered from the crypt of “La Ermita de la Soledad” (XVI–XVII centuries), located in the province of Huelva in the southwest of Spain. We extracted and analyzed aDNA in three independent laboratories, following specific procedures generally practiced in the aDNA field, including cloning of the amplified DNA fragments and sequencing of several clones. This is the most ancient case, reported to date, from which detection of DNA from T. pallidum subspecies pallidum has been successful in more than one individual, and we put forward a hypothesis to explain this result, taking into account the course of the disease in neonate individuals

Consensus report for workshop on ⇜early diagnosis and intervention in cerebral Palsy” Turkey’s approach to babies at risk and suggestions 1. National congress on babies at risk (1-4 March 2018, the Ankara Hotel)

The workshop on “Early Diagnosis and Intervention in Cerebral Palsy” aimed to reflect the current situation of and the challenges encountered in the early diagnosis and intervention in cerebral palsy in babies at risk, in order to raise awareness in the corresponding community by putting forth suggestions for providing solutions to these problems, and also, to provide a model suggestion suitable for the whole country. In the direction of these purposes, problems encountered in the prenatal, natal, and postnatal periods, and the corresponding suggestions were discussed, and vital topics concerning numerous disciplines, especially for the postnatal period, were emphasized in the workshop. With the aim of providing a solution to the current problems in the country regarding the matter, by employing an interdisciplinary approach, the establishment of Monitoring Centers for the Babies at Risk was proposed, and a model for these centers was created. Implications derived from this workshop will establish a foundation for the creation of a special strategic plan for the early diagnosis and intervention in cerebral palsy for the babies at risk. Copyright © 2018 by Türkiye Klinikleri

An Observational, Prospective, Multicenter, Registry-Based Cohort Study Comparing Conservative and Medical Management for Patent Ductus Arteriosus.

No consensus has been reached on which patent ductus arteriosus (PDAs) in preterm infants require treatment and if so, how, and when they should be treated. A prospective, multicenter, cohort study was conducted to compare the effects of conservative approaches and medical treatment options on ductal closure at discharge, surgical ligation, prematurity-related morbidities, and mortality. Infants between 24(0/7) and 28(6/7) weeks of gestation from 24 neonatal intensive care units were enrolled. Data on PDA management and patients' clinical characteristics were recorded prospectively. Patients with moderate-to-large PDA were compared. Among the 1,193 enrolled infants (26.7 ± 1.4 weeks and 926 ± 243 g), 649 (54%) had no or small PDA, whereas 544 (46%) had moderate-to-large PDA. One hundred thirty (24%) infants with moderate-to-large PDA were managed conservatively, in contrast to 414 (76%) who received medical treatment. Eighty (62%) of 130 infants who were managed conservatively did not receive any rescue treatment and the PDA closure rate was 53% at discharge. There were no differences in the rates of late-onset sepsis, necrotizing enterocolitis (NEC), retinopathy of prematurity, intraventricular hemorrhage (≥Grade 3), surgical ligation, and presence of PDA at discharge between conservatively-managed and medically-treated infants (p > 0.05). Multivariate analysis including perinatal factors showed that medical treatment was associated with increased risk for mortality (OR 1.68, 95% Cl 1.01-2.80, p = 0.046), but decreased risk for BPD or death (BPD/death) (OR 0.59, 95%Cl 0.37-0.92, p = 0.022). The preferred treatment options were ibuprofen (intravenous 36%, oral 31%), and paracetamol (intravenous 26%, oral 7%). Infants who were treated with oral paracetamol had higher rates of NEC and mortality in comparison to other treatment options. Infants treated before postnatal day 7 had higher rates of mortality and BPD/death than infants who were conservatively managed or treated beyond day 7 (p = 0.009 and 0.007, respectively). In preterm infants born at <29 weeks of gestation with moderate-to-large PDA, medical treatment did not show any reduction in the rates of open PDA at discharge, surgical or prematurity-related secondary outcomes. In addition to the high incidence of spontaneous closure of PDA in the first week of life, early treatment (<7 days) was associated with higher rates of mortality and BPD/death

Arteriosus

No consensus has been reached on which patent ductus arteriosus (PDAs) in preterm infants require treatment and if so, how, and when they should be treated. A prospective, multicenter, cohort study was conducted to compare the effects of conservative approaches and medical treatment options on ductal closure at discharge, surgical ligation, prematurity-related morbidities, and mortality. Infants between 24(0/7)and 28(6/7)weeks of gestation from 24 neonatal intensive care units were enrolled. Data on PDA management and patients' clinical characteristics were recorded prospectively. Patients with moderate-to-large PDA were compared. Among the 1,193 enrolled infants (26.7 +/- 1.4 weeks and 926 +/- 243 g), 649 (54%) had no or small PDA, whereas 544 (46%) had moderate-to-large PDA. One hundred thirty (24%) infants with moderate-to-large PDA were managed conservatively, in contrast to 414 (76%) who received medical treatment. Eighty (62%) of 130 infants who were managed conservatively did not receive any rescue treatment and the PDA closure rate was 53% at discharge. There were no differences in the rates of late-onset sepsis, necrotizing enterocolitis (NEC), retinopathy of prematurity, intraventricular hemorrhage (>= Grade 3), surgical ligation, and presence of PDA at discharge between conservatively-managed and medically-treated infants (p> 0.05). Multivariate analysis including perinatal factors showed that medical treatment was associated with increased risk for mortality (OR 1.68, 95% Cl 1.01-2.80,p= 0.046), but decreased risk for BPD or death (BPD/death) (OR 0.59, 95%Cl 0.37-0.92,p= 0.022). The preferred treatment options were ibuprofen (intravenous 36%, oral 31%), and paracetamol (intravenous 26%, oral 7%). Infants who were treated with oral paracetamol had higher rates of NEC and mortality in comparison to other treatment options. Infants treated before postnatal day 7 had higher rates of mortality and BPD/death than infants who were conservatively managed or treated beyond day 7 (p= 0.009 and 0.007, respectively). In preterm infants born at <29 weeks of gestation with moderate-to-large PDA, medical treatment did not show any reduction in the rates of open PDA at discharge, surgical or prematurity-related secondary outcomes. In addition to the high incidence of spontaneous closure of PDA in the first week of life, early treatment (<7 days) was associated with higher rates of mortality and BPD/death.C1 [Okulu, Emel; Erdeve, Omer; Arsan, Saadet] Ankara Univ, Sch Med, Dept Pediat, Div Neonatol, Ankara, Turkey.[Arslan, Zehra] Univ Hlth Sci, Etlik Zubeyde Hanim Womens Hlth Teaching & Res Ho, Dept Neonatol, Ankara, Turkey.[Demirel, Nihal] Ankara Yildirim Beyazit Univ, Sch Med, Dept Pediat, Div Neonatol, Ankara, Turkey.[Kaya, Huseyin; Gokce, Ismail Kursad] Inonu Univ, Sch Med, Dept Pediat, Div Neonatol, Malatya, Turkey.[Ertugrul, Sabahattin] Dicle Univ, Sch Med, Dept Pediat, Div Neonatol, Diyarbakir, Turkey.[Cetinkaya, Merih; Buyukkale, Gokhan] Univ Hlth Sci, Kanuni Sultan Suleyman Training & Res Hosp, Dept Neonatol, Istanbul, Turkey.[Ozlu, Ferda; Simsek, Huseyin] Cukurova Univ, Sch Med, Dept Pediat, Div Neonatol, Adana, Turkey.[Celik, Yalcin] Mersin Univ, Sch Med, Dept Pediat, Div Neonatol, Mersin, Turkey.[Ozkan, Hilal; Koksal, Nilgun] Uludag Univ, Sch Med, Dept Pediat, Div Neonatol, Bursa, Turkey.[Akcan, Baris; Turkmen, Munevver] Adnan Menderes Univ, Sch Med, Dept Pediat, Div Neonatol, Aydin, Turkey.[Celik, Kiymet] Diyarbakir Gazi Yasargil Training & Res Hosp, Neonatal Intens Care Unit, Diyarbakir, Turkey.[Armangil, Didem] Koru Hosp, Neonatal Intens Care Unit, Ankara, Turkey.[Bulbul, Ali] Univ Hlth Sci, Sisli Etfal Hamidiye Training & Res Hosp, Dept Neonatol, Istanbul, Turkey.[Tekgunduz, Kadir Serafettin] Ataturk Univ, Sch Med, Dept Pediat, Div Neonatol, Erzurum, Turkey.[Oncel, Mehmet Yekta] Izmir Katip Celebi Univ, Sch Med, Dept Pediat, Div Neonatol, Izmir, Turkey.[Tuzun, Funda] Dokuz Eylul Univ, Sch Med, Dept Pediat, Div Neonatol, Izmir, Turkey.[Ergenekon, Ebru] Gazi Univ, Sch Med, Dept Pediat, Div Neonatol, Ankara, Turkey.[Ergin, Hacer] Pamukkale Univ, Sch Med, Dept Pediat, Div Neonatol, Denizli, Turkey