Spontaneous regression of congenital epulis: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Congenital epulis is a rare lesion found on the alveolar process of a newborn child, diagnosed soon after birth. The lesion has a site predilection for the anterior maxillary alveolar process and a 9:1 sex predilection for females. Once diagnosed the traditional management of the lesion has been surgical excision under general anesthesia.</p> <p>Case presentation</p> <p>The purpose of this case report is to describe spontaneous regression of congenital epulis in a three week old healthy African American female child. She presented with a 1.5 cm bilobed sessile nodular lesion in the region of the right maxillary cuspid. The clinical impression was congenital epulis. Since the lesion was not interfering with feeding and respiration, a conservative approach was taken. The child was followed-up for 18 months, during which the lesion progressively regressed.</p> <p>Conclusions</p> <p>Conservative management prevented unnecessary surgery and anesthesia exposure in a neonate.</p

Survey of childhood empyema in Asia: Implications for detecting the unmeasured burden of culture-negative bacterial disease

<p>Abstract</p> <p>Background</p> <p>Parapneumonic empyema continues to be a disease of significant morbidity and mortality among children despite recent advances in medical management. To date, only a limited number of studies have assessed the burden of empyema in Asia.</p> <p>Methods</p> <p>We surveyed medical records of four representative large pediatric hospitals in China, Korea, Taiwan and Vietnam using <it>ICD</it>-10 diagnostic codes to identify children <16 years of age hospitalized with empyema or pleural effusion from 1995 to 2005. We also accessed microbiology records of cultured empyema and pleural effusion specimens to describe the trends in the epidemiology and microbiology of empyema.</p> <p>Results</p> <p>During the study period, we identified 1,379 children diagnosed with empyema or pleural effusion (China, n = 461; Korea, n = 134; Taiwan, n = 119; Vietnam, n = 665). Diagnoses of pleural effusion (n = 1,074) were 3.5 times more common than of empyema (n = 305), although the relative proportions of empyema and pleural effusion noted in hospital records varied widely between the four sites, most likely because of marked differences in coding practices. Although pleural effusions were reported more often than empyema, children with empyema were more likely to have a cultured pathogen. In addition, we found that median age and gender distribution of children with these conditions were similar across the four countries. Among 1,379 empyema and pleural effusion specimens, 401 (29%) were culture positive. <it>Staphylococcus aureus </it>(n = 126) was the most common organism isolated, followed by <it>Streptococcus pneumoniae </it>(n = 83), <it>Pseudomonas aeruginosa </it>(n = 37) and <it>Klebsiella </it>(n = 35) and <it>Acinetobacter </it>species (n = 34).</p> <p>Conclusion</p> <p>The age and gender distribution of empyema and pleural effusion in children in these countries are similar to the US and Western Europe. <it>S. pneumoniae </it>was the second leading bacterial cause of empyema and pleural effusion among Asian children. The high proportion of culture-negative specimens among patients with pleural effusion or empyema suggests that culture may not be a sufficiently sensitive diagnostic method to determine etiology in the majority of cases. Future prospective studies in different countries would benefit from standardized case definitions and coding practices for empyema. In addition, more sensitive diagnostic methods would improve detection of pathogens and could result in better prevention, treatment and outcomes of this severe disease.</p

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Seasonal changes of zooplankton species and groups composition in iskenderun bay (North East Levantine, Mediterranean Sea)

This study was carried out between January 2002 and November 2002 in the northern part of Iskenderun Bay (off shore of Yumurtalik-Kokar Cape) in the northeastern Mediterranean to determine seasonal changes of zooplankton. Samples were collected seasonally at 13 sations using WP2 net of 200 µ m mesh by vertical and horizantal hauls. 29 species of copepods, 4 species of cladocera, 11 groups of holoplankton and 9 groups of meroplankton were determined in spring; 17 species of copepods, 4 species of cladocera and 8 groups of holoplankton and meroplankton, respectively, were determined in summer; 23 species of copepods, 2 species of cladocera, 10 groups of holoplankton and 7 groups of meroplankton were determined in autumn and 34 species of copepods, 12 groups of holoplankton and 7 groups of meroplankton were determined in winter. Lessepsian species were recorded in the area such as Calanopia elliptica, Labidocera pavo, Pontellina plumata, Centropages furcatus. © Copyright 2016 Zoological Society of Pakistan

Effects of freshwater and seawater on growth, total testosterone levels and testis development of tilapias

Effects of freshwater and seawater on growth, total testosterone levels, testis development of Oreochromis niloticus, Oreochromis aureus and Tilapia zilli were determined in this study. Although seawater affected the growth of fishes positively (p<0.05) and all testis development stages (immature, maturing and maturated) were observed in all species in seawater, total testosterone concentrations of the fishes grown in this environment did not reach the levels seen in the fishes grown in freshwater (p<0.05). In addition, in seawater, gonad development was observed later and the last 2 gonadal stages were seen together in all species. © Medwell Journals, 2008

Anesthetic effect of intrauterine lidocaine plus naproxen sodium in endometrial biopsy.

OBJECTIVE: To compare the efficacy of intrauterine lidocaine with oral naproxen sodium on pain perception of the patients during endometrial biopsy using the Pipelle instrument and to investigate their effects when used in combination

Rotifera and Cladocera fauna of the River Seyhan (the part within borders of Adana city) [Seyhan Nehrinin (Adana i·l Merkezi sinirlari i·çindeki bölümünde) Rotifera ve Cladocera faunasi]

In this study between November 1991 and October 1992, the unexplored Rotifera and Cladocera faunas were investigated both qualitatively and quantitatively in the part within borders of Adana city. The research yielded 17 spp. and 1 subsp. of Rotifera and 9 ssp. of Cladocera

Comparison of the fatty acid composition of the freshwater fish larvae Tilapia zillii, the rotifer Brachionus calyciflorus, and the microalgae Scenedesmus abundans, Monoraphidium minitum and Chlorella vulgaris in the algae-rotifer-fish larvae food chains

The proximate and the fatty acid analysis of the warm freshwater fish, Tilapia zillii larvae, the freshwater rotifer Brachionus calyciflorus and the microalgae Scenedesmus abundans, Monoraphidium minitum and Chlorella vulgaris each constituting a different food chain with B. calyciflorus and T. zillii larvae have been carried out. C. vulgaris had significantly higher lipid content than the other two microalgae and this was also reflected in the lipid content of B. calyciflorus fed each of the microalgae separately. Five fatty acids dominated in all the microalgae, namely 18:3n - 3, 18:2n - 6, 18:0, 18:1 and 16:0 though there were significant differences both in quantitative distribution of these acids and the total fatty acid content. The content of 18:3n-3, 18:2n-6 and 16:0 and the total fatty acid content of C. vulgaris were considerably higher than the corresponding values in the other two microalgae. But interestingly, these strong differences were not reflected in B. calyciflorus samples fed these microalgae separately though the one fed C. vulgaris had slightly higher total fatty acid content than the other two rotifer samples. One can consider that the freshwater rotifer B. calyciflorus is capable of creating its own characteristic fatty acid content up to a sufficient level even when cultured with a fatty acid deficient algae probably by consuming excessive amounts of this algae compared to other algae of relatively high fatty acid content. The proximate and fatty acid analysis results of the three T. zillii larvae fed the three B. calyciflorus samples obtained by culturing with three different microalgae were very similar. This was an expected result because the three B. calyciflorus samples did not differ much from each other. The low 18:2n - 6 (1.66-3.53 mg g-1 DM) and 18:3n - 3 (1.14-1.22 mg g-1 DM) content and the relatively high 22:6n - 3 (10.7214.38 mg g-1 DM) content of the T. zillii larvae samples indicated that they were capable of elongating and desaturating both linoleic and linolenic acids of the B. calyciflorus samples