Successful Treatment of a Neonate with Idiopathic Persistent Pulmonary Hypertension with Inhaled Nitric Oxide via Nasal Cannula without Mechanical Ventilation.

We report a case study of a term neonate presenting with oxygen desaturation without respiratory distress or acidosis, despite receiving 100% oxygen through a nasal cannula. Echocardiogram showed evidence of persistent pulmonary hypertension of the newborn (PPHN). She was successfully treated with inhaled nitric oxide (iNO) via nasal cannula without requiring mechanical ventilation. In a term neonate with idiopathic PPHN with adequate respiratory drive without any parenchymal lung disease, noninvasive methods of iNO delivery may treat the condition without the complications associated with mechanical ventilation

Effect of various inspired oxygen concentrations on pulmonary and systemic hemodynamics and oxygenation during resuscitation in a transitioning preterm model.

BackgroundThe Neonatal Resuscitation Program recommends initial resuscitation of preterm infants with low oxygen (O2) followed by titration to target preductal saturations (SpO2). We studied the effect of resuscitation with titrated O2 on gas exchange, pulmonary, and systemic hemodynamics.MethodologyTwenty-nine preterm lambs (127 d gestation) were randomized to resuscitation with 21% O2 (n = 7), 100% O2 (n = 6), or initiation at 21% and titrated to target SpO2 (n = 16). Seven healthy term control lambs were ventilated with 21% O2.ResultsPreductal SpO2 achieved by titrating O2 was within the desired range similar to term lambs in 21% O2. Resuscitation of preterm lambs with 21% and 100% O2 resulted in SpO2 below and above the target, respectively. Ventilation of preterm lambs with 100% O2 and term lambs with 21% O2 effectively decreased pulmonary vascular resistance (PVR). In contrast, preterm lambs with 21% O2 and titrated O2 demonstrated significantly higher PVR than term lambs on 21% O2.Conclusion(s)Initial resuscitation with 21% O2 followed by titration of O2 led to suboptimal pulmonary vascular transition at birth in preterm lambs. Ventilation with 100% O2 in preterm lambs caused hyperoxia but reduced PVR similar to term lambs on 21% O2. Studies evaluating the initiation of resuscitation at a higher O2 concentration followed by titration based on SpO2 in preterm neonates are needed

Analysis of cytology of germ cell tumors with histopathological and serum tumor marker correlation: a tertiary care centre experience

Background: Germ cell tumors are found primarily in children and young adults usually arising from gonads and rarely from extragonadal sites like mediastinum, retroperitoneum, pineal gland and sacrococcygeal region. Involvement of lymphnodes or bodycavities (pleural/peritoneal cavity) is usually associated with metastatic disease.Methods: This is a retrospective analysis of 96 cases of germ cell tumor for which a primary diagnosis of germ cell tumor was given by cytology from primary and metastatic sites. The study period is from January 1993- December 2013. Pap stained and Romanowsky stained smears and cell block sections (10cases) were studied. Serum tumor markers (LDH, BetaHCG and AFP) were correlated in all cases along with histopathology in available cases.Results: Among 96 cases 34 were diagnosed as seminoma/dysgerminoma,10 as embryonal carcinoma,9 as yolk sac tumor,6 as teratoma and 2 as mixed germ ell tumor. In 25 cases the cytology report was suggestive of germ cell tumor and in 10 cases malignant cells favouring germ cell tumor. Among the 10 cases the serum markers were high in six of the cases and the clinician after discussing with the pathologist treated them as germ cell tumors. 47 cases had histopathology and it correlated with cytology except in 14 cases which showed no residual neoplasm after chemotherapy. 15 cases expired immediately after the diagnosis or during the course of treatment 12cases were lost to follow up. Rest of the cases have completed the treatment. In our study the serum tumor markers showed a sensitivity of 92.75% and positive predictive value was 71.11%.Conclusions: The study highlights the importance of picking up the diagnosis of germ cell tumors by fine needle aspiration cytology so that patient can get an early diagnosis, effective treatment and a multidisciplinary approach is essential in diagnosing a difficult case of germ cell tumor. Previous history, radiology, clinical features and serum tumor markers all aid in the cytological diagnosis of germ cell tumor

Tracheal suctioning improves gas exchange but not hemodynamics in asphyxiated lambs with meconium aspiration.

BackgroundCurrent neonatal resuscitation guidelines recommend tracheal suctioning of nonvigorous neonates born through meconium-stained amniotic fluid.MethodsWe evaluated the effect of tracheal suctioning at birth in 29 lambs with asphyxia induced by cord occlusion and meconium aspiration during gasping.ResultsTracheal suctioning at birth (n = 15) decreased amount of meconium in distal airways (53 ± 29 particles/mm(2) lung area) compared to no suction (499 ± 109 particles/mm(2); n = 14; P < 0.001). Three lambs in the suction group had cardiac arrest during suctioning, requiring chest compressions and epinephrine. Onset of ventilation was delayed in the suction group (146 ± 11 vs. 47 ± 3 s in no-suction group; P = 0.005). There was no difference in pulmonary blood flow, carotid blood flow, and pulmonary or systemic blood pressure between the two groups. Left atrial pressure was significantly higher in the suction group. Tracheal suctioning resulted in higher Pao2/FiO2 levels (122 ± 21 vs. 78 ± 10 mm Hg) and ventilator efficiency index (0.3 ± 0.05 vs.0.16 ± 0.03). Two lambs in the no-suction group required inhaled nitric oxide. Lung 3-nitrotyrosine levels were higher in the suction group (0.65 ± 0.03 ng/µg protein) compared with the no-suction group (0.47 ± 0.06).ConclusionTracheal suctioning improves oxygenation and ventilation. Suctioning does not improve pulmonary/systemic hemodynamics or oxidative stress in an ovine model of acute meconium aspiration with asphyxia

Viral Infections and Neonatal Necrotizing Enterocolitis: A Meta-analysis.

CONTEXT: Necrotizing enterocolitis (NEC) is a devastating intestinal disease affecting preterm infants. Studies implicate viral infections in etiopathogenesis. OBJECTIVE: To summarize the association of viral infections with NEC by systematic review and meta-analysis. DATA SOURCES: We searched Ovid-Medline, Embase, Web of Science, and Cochrane databases in November 2022. STUDY SELECTION: We included observational studies that examined the association between viral infections and NEC in newborn infants. DATA EXTRACTION: We extracted data regarding the methodology, participant characteristics, and outcome measures. RESULTS: We included 29 and 24 studies in the qualitative review and meta-analysis, respectively. The meta-analysis demonstrated a significant association between viral infections and NEC (odds ratio [OR], 3.81, 95% confidence interval: 1.99-7.30, 24 studies). The association remained significant after excluding the outliers (OR, 2.89 [1.56-5.36], 22 studies) and studies with poor methodology (OR, 3.33 [1.73-6.43], 22 studies). In subgroup analysis based on participants\u27 birth weight, studies including very low birth weight infants only (OR, 3.62 [1.63-8.03], 8 studies) and non-very low birth weight infants only (OR, 5.28 [1.69-16.54], 6 studies) showed a significant association. In subgroup analysis based on specific viruses, infection with rotavirus (OR, 3.96 [1.12-13.95], 10 studies), cytomegalovirus (OR, 3.50 [1.60-7.65], 5 studies), norovirus (OR, 11.95 [2.05-69.84], 2 studies), and astrovirus (OR, 6.32 [2.49-16.02], 2 studies) was significantly associated with NEC. LIMITATIONS: Heterogeneity of the included studies. CONCLUSIONS: Viral infection is associated with an increased risk of NEC in newborn infants. We need methodologically sound prospective studies to assess the effect of preventing or treating viral infections on NEC incidence

Surface Chemical Analysis of Solid-Electrolyte Interphase Layer on Germanium Thin Films and the Effect of Vinylene Carbonate Electrolyte Additive

Germanium thin-film anodes for Li-ion battery applications are the focus of the present work. As part of this chapter, we shall briefly review the use of germanium thin films in Li-ion batteries, and subsequently, new results pertaining to the effect of vinylene carbonate (VC) as electrolyte additive on the electrochemical performance are presented. We have used cyclic voltammetry, galvanostatic charge-discharge and electrochemical impedance spectroscopy to investigate the performance. Thin-film electrode performance with 0 wt. %, 5 wt. %, and 10 wt.% VC as electrolyte additive was compared to understand the role of additive’s concentration. The cell with 5 wt.% VC as electrolyte additive exhibited best performance with high specific capacity of 975 mAh/g, with a retention of 94 and 99% Coulombic efficiency at the end of 100 cycles. Ex situ surface chemical analysis of the solid-electrolyte interphase (SEI) layer has been studied in detail using X-ray photoelectron spectroscopy and correlated with the electrochemical performance

Concordance between Radiological Features and Histopathological Diagnosis of Cartilaginous Lesions of Bone among Patients at a Tertiary Care Centre, Trivandrum, Kerala

Introduction: Cartilaginous tumours comprise a large, heterogeneous group of mesenchymal neoplasms. They pose a challenge in terms of accurate diagnosis and management. Histopathological findings have direct implications for treatment outcomes. Aim: To determine the concordance between the radiological features and the histopathological diagnosis of cartilaginous lesions of bone. Materials and Methods: This was a retrospective study conducted in the Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India, among 109 patients with histopathologically proven benign and malignant cartilaginous tumours, received in the laboratory between January 2012 and December 2021 for a duration of 10 years, were analysed. The study was conducted between September 2019 and January 2022. The demographic data for the study, including age, tumour site, clinical findings, and radiological diagnosis, were obtained from medical records. The cases were histopathologically graded based on the World Health Organization 2020 classification of tumours of soft tissue and bone. The concordance between histopathological diagnosis and radiological features was assessed. The Chi-square test was used to find the association between two categorical variables, and the Independent sample t-test was used to find the difference between two groups with respect to mean and standard deviation. Results: There were a total of 109 cases of cartilaginous tumours, out of which 82 cases (75.22%) were diagnosed as malignant and 27 cases (24.77%) were diagnosed as benign. Among benign neoplasms, chondroblastoma and osteochondroma were the most common, with 10 cases (37.03%) each. Among malignant chondroid tumours, 73 (89.02%) were diagnosed as conventional chondrosarcoma. There were five cases (6.09%) of secondary chondrosarcomas (malignant transformation of a benign cartilaginous lesion). Among the secondary chondrosarcomas, three cases (60%) were malignant transformation in osteochondroma, 1 (20%) in enchondroma, and 1 (20%) in synovial chondromatosis. Among the 91 cases for which radiology was available, 86 (94.50%) had a concordance between radiological and histopathological diagnosis. Five cases (5.49%) had a discordant radiological diagnosis. Conclusion: For histologically benign tumours, the radiological findings in the study were identical and concordant. For histologically malignant tumours, there were discrepancies with radiological findings in this study when the lesion had an associated cyst, absence of cortical destruction, or absence of a clear cartilaginous component and extra cortical expansion. For histologically suspicious cases in the study, the final diagnosis was made based upon radiological findings, with a particular interest in cortical destruction