A Rare Preterm Newborn Case of Rib Osteomyelitis with Intrathoracic Involvement

Background: Rib osteomyelitis is a very rare form of pediatric osteomyelitis. Case report: Herein, we reported a very rare case of chest wall abscess with rib osteomyelitis and rib destruction due to Staphylococcus aureus infection in a 14-day-old preterm male neonate. The diagnosis of this uncommon disease requires a high index of suspicion due to its rarity and non-specific clinical presentation. The radiographic findings of osteomyelitis usually require 7-14 days to appear. Ultrasonography enabled us to diagnose a coexisting intra- and extra-thoracic solid mass with calcification. In addition, the chest high resolution computed tomography scan revealed rib osteomyelitis, which was not possible to be detected through the routine chest radiography. Following the administration of intensive parenteral antibiotic therapy for 21 days, the patient was discharged in good health condition at 42 days of age. He continued oral clindamycin consumption for the next three weeks. At the end of the six weeks of treatment, the chest X-ray revealed the expansion of the fifth rib end; however, the chest ultrasound showed no obvious fluid collection. Conclusion: As indicated in the present case report, the diagnosis of rib osteomyelitis requires a high index of suspicion given its nonspecific clinical manifestations that can easily mimic other diagnoses .The unusual sites of bone infection could be diagnosed by means of HRCT, followed by ultrasound. The prompt treatment leads to a high cure rate with good prognosis

Neural Coding and Models for Natural Sounds Recognition: Effects of Temporal and Spectral Features

The mammalian brain is able to recognize natural sounds in the presence of acoustic uncertainties such as background noise. A prevailing theory of neural coding suggest that neural systems are optimized for natural environment signals and sensory inputs that are biologically relevant. The optimal coding hypothesis thus suggests that neural populations should encode sensory information so as to maximize efficient utilization of environmental inputs. In the first part of my thesis, I will explore the origins of scale invariance phenomena which has been previously described for natural sounds and has been observed in a variety of natural sensory signals including natural scenes. In the second part, I will explore the ability of the brain to utilize high-level statistical regularities in natural sounds to perform sound identification tasks. Using a catalog of natural sounds, texture synthesis procedures to manipulate sounds statistics from various sound categories, and neural recordings from the auditory midbrain of awake rabbits, I will show that neural population response statistics can be used to identify discrete sound categories. In the last part of the thesis, I will explore the role of hierarchical organization in the auditory pathway for sound recognition and optimal coding in the presence of challenging background noise. Using neural responses from auditory nerve, midbrain, and auditory cortex, I developed optimal computational neural network model for word recognition in presence of speech babble noise. I demonstrate that the optimal computational strategy for word recognition in noise predicts various transformations performed by the ascending auditory pathway, including a sequential loss of temporal and spectral resolution, increasing sparseness and selectivity

Spiking network optimized for word recognition in noise predicts auditory system hierarchy

The auditory neural code is resilient to acoustic variability and capable of recognizing sounds amongst competing sound sources, yet, the transformations enabling noise robust abilities are largely unknown. We report that a hierarchical spiking neural network (HSNN) optimized to maximize word recognition accuracy in noise and multiple talkers predicts organizational hierarchy of the ascending auditory pathway. Comparisons with data from auditory nerve, midbrain, thalamus and cortex reveals that the optimal HSNN predicts several transformations of the ascending auditory pathway including a sequential loss of temporal resolution and synchronization ability, increasing sparseness, and selectivity. The optimal organizational scheme enhances performance by selectively filtering out noise and fast temporal cues such as voicing periodicity, that are not directly relevant to the word recognition task. An identical network arranged to enable high information transfer fails to predict auditory pathway organization and has substantially poorer performance. Furthermore, conventional single-layer linear and nonlinear receptive field networks that capture the overall feature extraction of the HSNN fail to achieve similar performance. The findings suggest that the auditory pathway hierarchy and its sequential nonlinear feature extraction computations enhance relevant cues while removing non-informative sources of noise, thus enhancing the representation of sounds in noise impoverished conditions

The Acute Temporary Peritoneal Dialysis in Neonates: A Five-Year Experience

Background: The aim of this prospective study was to evaluate the characteristics of patients, treated by acute peritoneal dialysis (PD). We also assessed the indications for PD, PD-associated complications and neonatal outcomes in our patients. Methods: During five years, 30 term newborns underwent temporary cycling PD. The procedure was performed by applying the manual technique. A straight and relatively rigid peritocat catheter (Germany) was percutaneously inserted in neonates. Statistical analysis was performed, using Chi-square and student's t-test. Results: All subjects were term newborns, including 16 females (52%) and 14 males (48%). In total, 16 cases (52%) were born via cesarean section. The average age and weight of neonates at catheter insertion were 15 days (range of 5-26 days) and 2800 g (range of 2300-4060 g), respectively. The mean PD duration was two days. There was no significant difference between gender, weight, mode of delivery and associated complications. In total, 74% of patients needed assisted ventilation. No case of death was reported due to catheter insertion; however, 12 patients (40%) died during PD. PD-related complications were reported in 70% of patients, and the most common complication was catheter outflow failure (14 cases, 46%). The underlying causes included inborn errors of metabolism (16 cases, 52%) and acute renal failure (14 cases, 48%). Urea cycle enzyme defect, along with hyperammonemia, was the most common etiologic disease (9 cases). Conclusion: PD is an effective treatment for seriously ill newborns with life-threatening conditions such as acute renal failure or certain inborn errors of metabolism. However, mortality rate remains high due to the severity of underlying diseases and comorbidities

The Investigation of Effects of Blood Exchange Transfusion on Selenium in Newborn Infants by Instrumental Neutron Activation Analysis Method

Objective: The evidence for the effects of blood exchange transfusion on selenium (Se) in newborn infants is unknown. This study was conducted to determine the possible effects of blood exchange transfusion on Se by comparing the Se blood concentrations before and after exchange transfusion in jaundiced neonates. Methods: A total of 30 jaundiced term neonates who underwent blood exchange transfusion (EXT) for first time because of idiopathic unconjugated hyperbilirubinemia, were recruited. The Se level of 30 blood bank donors' samples used for EXT were measured and 30 pairs of uncontaminated umbilical cord blood samples were investigated for Se before and after exchange transfusion. The samples were analyzed by instrumental neutron activation analysis method. Serum bilirubin concentrations were measured by venous blood samples before EXT. Findings: The average of Se concentration before EXT was higher than that after EXT (629.78±283.82 SD ppb versus 454.83±213.75 SD ppb) (P<0.05). There was significant correlation between the blood concentration of Se before and after EXT and also between the blood level of Se before EXT and total serum bilirubin level (P<0.05). There was no significant correlation between the blood concentration of Se before EXT and babies' gender and weight (P>0.05). The average Se level in samples obtained from transfused blood products was 507.90±223.56 SD ppb. ±Conclusion: Blood exchange transfusion caused a 28% decrease of the blood Se level because the blood donors had lower blood Se levels than the newborns. Furthermore, there was a significant correlation between the blood level of Se before EXT and the total serum bilirubin level

Serum level of vitamin D in preterm infants and its association with premature-related respiratory complications: a case-control study

Background and aim: Prematurity and related problems, especially respiratory distress, are one of the main challenges for neonatal medicine. The aim of this study was to compare vitamin D levels in preterm infants with, and those without respiratory distress. Methods: This case-control study was conducted in Ghaem and Emam Reza Hospitals in Mashhad (Iran) from 2015 to 2016. In this study, we examined 160 preterm infants weighing less than 2000 grams and born at less than 34 weeks’ gestation. Serum vitamin D levels were measured in preterm infants without- and those with respiratory distress, and their mothers. Neonatal characteristics, including age, sex, birth weight, gestational age, Apgar score and needs for oxygen, resuscitation, ventilation and surfactant were documented. The data were analyzed using SPSS version 16.0. Results: Means serum level of maternal vitamin D in control and case groups were 16.66±14.29 ng/dl and 21.23±15.19 ng/dl, respectively (p=0.029). In addition, mean serum level of neonatal vitamin D in control and case groups were 11.69±8.66 ng/dl 17.9±12.55 ng/dl, respectively (p=0.001). Vitamin D levels in premature neonates without respiratory distress and their mothers were significantly different from other preterm neonates with respiratory distress (p=0.029). There was a direct correlation with neonatal and maternal vitamin D levels (r=0.713, p=0.001). The duration of hospitalization (p=0.001), gestational age (p=0.073), birth weight (p=0.001), one- and (p=0.001) five- minute (p=0.001) Apgar scores and head circumference (p=0.002) had significant relation with vitamin D levels in neonates. Death (12.5%) and pneumothorax (7.5%) were the main complications among cases with respiratory distress. Conclusion: According to the results of present research, neonatal vitamin D levels have a significant association with respiratory distress syndrome and maternal vitamin D levels

Retinopathy of Prematurity among 1000-2000 gram Birth Weight Newborn Infants

Objective: The goal of this study was to identify the risk factors of retinopathy of prematurity (ROP) in neonatal intensive care unitin preterm infants born with birth weight 1000-2000g or at gestational age less than 34 weeks. Material & Methods: From August 2000 to December 2001, 50 preterm newborn infants with birth weights less than 2000 g or gestational age less than 34 weeks admitted to the NICU were studied. Newborn infants with birth weight between 1200-2000g who received more than 6 hours oxygen and newborn infants with birth weight 1000-1200 g regardless of oxygen therapy, who survived until 4 weeks postnatal, were enrolled and followed. Patients underwent indirect ophthalmologic examination by two ophthalmologists between 4-8 weeks post partum. The newborn infants who had ROP were assigned to case group and those without ROP to control group, both groups were reexamined every 2-4 weeks or according to international classification of retinopathy of prematurity (ICROP) advice. Findings: Fifty newborn infants, 36 (72%) in control group, 14 (28%) in case group, were studied. Gestational age and birth weight of the patients with ROP were significantly lower than those of control group. Duration of oxygen therapy, hyperoxia, acidosis, hypercarbia, hypocarbia and phototherapy are suggested as risk factors contributing to ROP. Conclusion: The results of this study demonstrate that the ROP frequency remains elevated among premature and very low birth weight infants. Infants at risk for ROP should have screening eye examinations and proper treatment

A Case Report of Incontinentia Pigmenti in a Newborn with Positive Family History Extending Over Three Generations

Background: Incontinentia pigmenti (IP), also known as Bloch-Sulzberger syndrome, is a rare X-linked dominant genodermatosis that presents at the time of birth or soon after birth with cutaneous manifestation. This disorder may also affect the ectodermal tissues, such as the central nervous system, skeletal system, eyes, hair, nails, and teeth. The dermatological findings occur in four successive phases.Case report: Herein, we presented the case of a two day-old female newborn with inflammatory vesiculopustular lesions on the right forearm and lower limbs, who was in a good general condition. The patient had a history of similar disease in three other members of her family, who had dental abnormalities as the most common non-cutaneous manifestation. This case report highlighted the importance of a detailed diagnostic workup for the newborns with pustular skin disease.Conclusion: IP is a rare, x-linked dominant genodermatosis with multiple organs involvement. Dermatological abnormalities are the most prominent manifestation. The diagnosis is based on the clinical findings, the presence of positive family history of skin vesiculopustular lesions support the diagnosis. The skin lesions do not require specific treatment and prognosis depend to other organs involvement