Association of imperforate anus and congenital diaphragmatic hernia in one of a twins who conceived by Assisted Reproductive Technology (ART)

Introduction: Combination of congenital diaphragmatic hernia (CDH) and anorectal malformation (ARM) is rare. In this report, we describe a combination of imperforate anus and CDH in one of twins who conceived by Assisted Reproductive Technology (ART). Case Report: A female preterm newborn at 27 weeks of gestation was referred to our neonatal intensive care unit due to respiratory distress. She was conceived by ART and had combination of imperforate anus and CDH. She expired 18-hours after birth as a result of severe lung hemorrhage and there was no possibility of surgical repair due to poor clinical condition. Conclusions: In spite of the low incidence of birth defects in the ART-conceived babies, continuing surveillance of them is necessary and the report of their birth defects is helpful

Prevalence of Stroke in neonates who admitted with seizures in neonatal intensive care unit

How to Cite This Article: Farhadi R, Alaee AR, Alipour Z, Abbaskhanian A, Nakhshab M, Derakhshanfar H. Prevalence of Stroke in NeonatesWho Admitted With Seizures in Neonatal Intensive Care Unit. Iran J Child Neurol. Autumn 2015;9(4):41-47.AbstractObjectivePrevalence of neonatal stroke has been reported 1/2300-1/4000 live births and accounts for 12-20% of the cases of neonatal seizures. Although stroke has been introduced as the second cause of the neonatal seizures in literatures, it may remain unclear in diagnostic evaluations of seizure in neonates. This study was performed to assess the prevalence of stroke in neonates with seizure.Materials & MethodsIn this cross-sectional study, all neonates ≥ 28 weeks of gestation with a diagnosis of seizures admitted to the NICU of Boo-Ali Sina Hospital in Sari, north of Iran, were enrolled. Brain CT scan and a Transcranial Doppler ultrasonography were performed for the all cases. In cases that stroke were reported in one or two above modalities, an MRI was also performed and prevalence of stroke was reported. Putative risk factors of stroke were analyzed with univariate and multivariate statistical methods.ResultsFrom 174 newborn infants, 75.3% of neonates were male. Prevalence of stroke was 8%, 2.3% and 3.4% in Doppler ultrasonography, CT scan and MRI reports respectively. Umbilical venous catheterization was the risk factor of stroke in the univariate and multivariate analysis (P= 0.001; OR, 10.39; 95% CI, 2.72-39.77). The most common form of seizure was focal clonic seizures (78.6%) in neonates with stroke.ConclusionInvestigation of stroke as an etiology of neonatal seizures is essential because seizure may be the only symptom of neonatal cerebral infarction. Doppler ultrasonography can be a valuable diagnostic tool at first in critically ill neonates or in situations that MRI is not available primarily. Further studies with notice to outcome assessment of these infants recommended.

The impacts of prone position on the blood oxygen saturations and heart rates of preterm infants under the mechanical ventilation

Background: The methods of baby's position are an important critical factor in ventilation and oxygenation of tissues. Although the prone position as one of the recommended position has beneficial effect on the development of premature infants, little research has been done. Methods: In a clinical trial among mechanically ventilated infants, hospitalized in the neonatal intensive care units (NICUs), 35 preterm infants were selected in 2014-2015. Each infant was positioned in a supine (control group) and prone (case group) positions for 2 hours, respectively. The values of blood oxygen saturations (SpO2) and heart rates were assessed and recorded every 10 minutes by a cardio-respiratory monitoring device. Data analysis was performed using SPSS v.22. Results: The mean heart rates were 136.909±2.861 and 136.600±2.560 beats per minute in the supine and prone positions, respectively. Heart rates were within the normal ranges in both positions, but the range of fluctuation was slightly lower and statistically non-significant in the prone position (p-value=0.805). The average of SpO2 was 92.364% and 95.046% in the supine and prone positions, both of them were within the normal range. Conclusions: This study showed that the prone position compared to the supine position has a more favorable effect of SpO2 and heart rate fluctuations in preterm infants

The Comparison of Pain Caused by Suprapubic Aspiration and Transurethral Catheterization Methods for Sterile Urine Collection in Neonates: A Randomized Controlled Study

This study was performed to compare the levels of pain experienced by young infants undergoing either suprapubic aspiration (SPA) or transurethral catheterization (TUC) for the collection of sterile urine samples. This prospective randomized clinical trial was conducted in hospitalized neonates in a university-affiliated hospital. Patients who required urine cultures were randomly assigned into one of two groups, the SPA or TUC group. The infants’ faces were videotaped, and the changes in the facial expression and physiological parameters during the procedure were scored using the Premature Infant Pain Profile (PIPP) in a blind manner. The primary outcome was the severity of the pain experienced during each procedure, and the secondary outcomes were the success rate, the duration, and the complications of each procedure. Ninety-four percent of male infants in the TUC group and 77.3% in the SPA group were uncircumcised (P=0.1). The mean (SD) of the PIPP pain scores did not differ between groups (9.95 ± 3.7 in SPA and 9.64 ± 3.2 in TUC, P=0.6). The duration of TUC was longer. Both methods can be used to collect urine from neonates, but the difficulty of performing TUC on females and uncircumcised males should be considered

Clinical Study The Comparison of Pain Caused by Suprapubic Aspiration and Transurethral Catheterization Methods for Sterile Urine Collection in Neonates: A Randomized Controlled Study

This study was performed to compare the levels of pain experienced by young infants undergoing either suprapubic aspiration (SPA) or transurethral catheterization (TUC) for the collection of sterile urine samples. This prospective randomized clinical trial was conducted in hospitalized neonates in a university-affiliated hospital. Patients who required urine cultures were randomly assigned into one of two groups, the SPA or TUC group. The infants' faces were videotaped, and the changes in the facial expression and physiological parameters during the procedure were scored using the Premature Infant Pain Profile (PIPP) in a blind manner. The primary outcome was the severity of the pain experienced during each procedure, and the secondary outcomes were the success rate, the duration, and the complications of each procedure. Ninety-four percent of male infants in the TUC group and 77.3% in the SPA group were uncircumcised ( = 0.1). The mean (SD) of the PIPP pain scores did not differ between groups (9.95 ± 3.7 in SPA and 9.64 ± 3.2 in TUC, = 0.6). The duration of TUC was longer. Both methods can be used to collect urine from neonates, but the difficulty of performing TUC on females and uncircumcised males should be considered

The efficacy and safety of two different doses of caffeine in respiratory function of preterm infants

Background: Caffeine is widely used for prevention of apnea and helps successful extubation from mechanical ventilation. It facilitates the transition from invasive to noninvasive support and reduces duration of continuous positive airway pressure (CPAP) in preterm infants. The optimum caffeine dose in preterm infants has not been well-studied in terms of benefits and risks. We compared efficacy and safety of once versus twice-daily caffeine dose in premature infants. Methods: This study was a randomized clinical trial conducted in Bu-Ali Sina Teaching Hospital, Sari. Patients with gestational age of <37 weeks were included. Both groups received 20 mg/kg loading dose of caffeine intravenously followed by maintenance dose of 5 mg/kg/day in group 1 or 2.5 mg/kg every 12 hours in group 2. Extubation failure, CPAP failure and possibly adverse reactions were evaluated. Results: The mean of gestational age and birth weight were 32.27±3.23 (weeks) and 1824.5±702.54 (gr), respectively. The rate of extubation and CPAP failure and length of NICU stay were lower in twice-daily-group with no statistically significant difference. The means of O2 saturations on the first three days of caffeine therapy were higher in twice-daily-group. Caffeine was generally safe and well tolerated. Conclusions: This study, which assayed short-term effects of caffeine, showed that twice daily caffeine maintenance dose was related to more benefits in facilitating extubation or prevention of CPAP failure in preterm infants. However, there was not statistically significant difference between two groups

Comparison of the Effect of Sertraline and Escitalopram on the Treatment of Major Depressive Disorder in Hemodialysis Patients: A Randomized Controlled Trial

Background: We decided to compare the effects of sertraline and escitalopram in the treatment of major depressive disorder in hemodialysis patients. Materials and Methods: In this single-blind randomized clinical trial, 100 patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis with a Beck Depression Inventory (BDI) score greater than 15 who were not using medication for depression were included in the study. Then randomly assigned to two groups: (one receiving sertraline and one receiving escitalopram). Both groups were monitored using the Beck questionnaire at the end of the first, second, and third months. Additionally, side effects, treatment compliance, and mortality were compared between the two groups. Results: In total, 100 patients with ESRD were included in the study (48 in the sertraline treatment group and 52 in the escitalopram treatment group). The results indicate that in both treatment groups, depression rates significantly decreased over time with medication (P&lt;0.001). Comparing the depression scores over time revealed that the effect of sertraline and escitalopram in reducing depression was not significantly different. However, the depression score in the sertraline group was slightly lower than that in the escitalopram group, although this difference was not statistically significant. Side effects, treatment compliance, and mortality were comparable between the two groups. Conclusion: In general, both sertraline and escitalopram significantly reduced the score of depression in patients, but sertraline in reducing the depression score was greater than that of escitalopram, although this difference was not significant

Evaluation of antibody titers in COVID-19 patients with cerebral or pulmonary symptoms and mild symptoms

Background and Objectives: This study aimed to compare the production of antibodies in three different groups of patients with COVID-19. These groups included patients with pulmonary and cerebral symptoms, as well as those with mild symptoms. Materials and Methods: Blood samples were collected from 80 patients admitted to COVID-19-specific hospitals. The patients had various forms of SARS-CoV-2 disease, including those with pulmonary symptoms, brain involvement, and those with positive PCR test results but mild symptoms. The enzyme-linked immunosorbent assay (ELISA) technique was used to determine the levels of IgM and IgG antibody titers. Results: The levels of IgM and IgG antibody production differed significantly between groups of patients experiencing pulmonary symptoms and cerebral symptoms, with mild symptom patients also showing differences (P=0.0068), (P=0.0487), (P<0.0001), and (P=0.0120), respectively. Furthermore, there was no significant relationship between IgM antibody secretion and age or pulmonary involvement (P=0.1959). However, there was a direct and significant relationship between age and brain involvement (P=0.0317). Conclusion: The findings of this study revealed that the risk of central nervous system involvement increases with age and that older people have lower antibody levels than younger people. Consequently, strengthening the immune systems of people over the age of 78 during this pandemic through vaccination and nutrition is very effective in reducing mortality in this age group

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

The Global Burden of Diseases, Injuries and Risk Factors 2017 includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting