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Conversion to Open Repair During Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Risk Factors and Countermeasures
Ping Zhao,
Wei Zuo,
Wei Gao,
Xiang Liu
Issue:
Volume 8, Issue 3, September 2022
Pages:
152-157
Received:
17 June 2022
Accepted:
7 July 2022
Published:
20 July 2022
DOI:
10.11648/j.ajp.20220803.11
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Abstract: There are currently no general guidelines on the selection criteria for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) in neonates, and some patients who are not suitable for the thoracoscopic approach have to be converted to open repair (OR) after undergoing initial thoracoscopy. The aim of this study was to evaluate factors associated with conversion to OR during TR of neonatal cases of CDH and to explore countermeasures against conversion. Medical records of neonates who underwent thoracoscopy for Bochdalek-type CDH at a tertiary center from January 2013 to July 2019 were retrospectively reviewed. We defined two groups: the T group included neonates undergoing complete TR and the TO group included neonates requiring conversion to OR during TR. Thoracoscopy was performed in 58 neonates, with 48 in T group and 10 in TO group. The conversion rate was 17.2%. The proportion of patients with diaphragmatic defect size greater than 6 cm x 5 cm was significantly higher in the TO group than in the T group (30% vs. 2.08%; p = 0.014). The rate of patch use was significantly higher in the TO group compared to the T group (30% vs. 4.17%; p = 0.032). There was no statistically significant difference between the two groups in terms of stomach herniation or liver herniation. The postoperative recurrence rate was 17.78% in the T group and 0% in the TO group (p = 0.39). Defect size greater than 6 cm x 5 cm and patch use were associated with higher conversion rate, while stomach herniation and liver herniation were not. Patients who require conversion but are not actually converted to open repair may have a higher risk of postoperative recurrence.
Abstract: There are currently no general guidelines on the selection criteria for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) in neonates, and some patients who are not suitable for the thoracoscopic approach have to be converted to open repair (OR) after undergoing initial thoracoscopy. The aim of this study was to evaluate factors as...
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Predictors of Adverse Outcomes in Neonates with Seizures
Menna Ebrahim Hashish,
Ahmad Darwish,
Mohamed Reda Bassiouny
Issue:
Volume 8, Issue 3, September 2022
Pages:
158-167
Received:
23 June 2022
Accepted:
9 July 2022
Published:
20 July 2022
DOI:
10.11648/j.ajp.20220803.12
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Abstract: Background: Seizures in neonatal period could generate long-term neurodevelopmental impairment; therefore, explicit clarification of adverse outcome predictors should direct the ongoing and subsequent treatment plan. Objective: The study aimed to address predictors of adverse neurodevelopmental outcomes and/or mortality of full-term infants who developed neonatal seizures. Methods: This longitudinal prospective cohort study was conducted from 2019 to 2021 in tertiary hospital, Egypt and included the full-term infants till 18 months of age after occurrence of clinical/electrical seizures in neonatal period and healthy infants of matched age and sex. All infants were assessed by Bayley-III developmental scales in three main domains (cognitive, language and motor). The required data for the predictive factors of adverse outcome had been registered on REDCap tools and exported for statistical analysis. Results: Sixty four infants were enrolled (35 developed seizures and 29 were healthy), 29% died. There were significant group differences (better results were in favor of healthy infants) in the need for initial resuscitation, 1st and 5th minute APGAR score and in all developmental domains. Medium correlation was found between abnormal motor subscale and multiple attacks of seizures, the need for anti-seizure medication on discharge and low 5th minute APGAR score. Time to death was significant earlier in infants required initial resuscitation, developed seizures within 1st day of life with special characteristics (as exceeding 6 days with abnormal aEEG background, >2 anti-epileptic drugs were prescribed for optimum control and also were prescribed on their discharge plan) and also those exceeded 19 days admission in NICU. Conclusion: Occurrence of seizures in neonatal period had its unique signature on long-term morbidity. Early death and abnormal motor domain in later life could be predicted from the 1st days of birth though low APGAR score, frequency and duration of seizures, EEG background and the need for anti-seizure medication on discharge.
Abstract: Background: Seizures in neonatal period could generate long-term neurodevelopmental impairment; therefore, explicit clarification of adverse outcome predictors should direct the ongoing and subsequent treatment plan. Objective: The study aimed to address predictors of adverse neurodevelopmental outcomes and/or mortality of full-term infants who dev...
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Extrahepatal Cholestasis Due to Choledochal Cyst Type Iv Todani Classification in Two Years Old Girl
Luh Made Diah Wulandari Artana,
I Gusti Ngurah Sanjaya Putra,
Kadek Deddy Ariyanta,
I Putu Gede Karyana,
Ni Nyoman Metriani Nesa,
I Made Darmajaya
Issue:
Volume 8, Issue 3, September 2022
Pages:
168-172
Received:
5 July 2022
Accepted:
20 July 2022
Published:
28 July 2022
DOI:
10.11648/j.ajp.20220803.13
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Abstract: Choledocal cyst (CC) is a rare congenital cystic dilation of bile duct and can be associated with serious complications including malignancy and inflammation of the surrounding anatomy. Approximately 80% of CC is diagnosed in infants and young children in their first decade of life. Complete surgical resection is recommended in patients with choledochal malformations with excellent outcome. Hereby we aimed to describe diagnosis and management aspects of choledochal cyst. A two years old girl complained intermittent abdominal pain in her upper right quadrant abdomen, accompanied with fever, nausea and vomiting and decrease of appetite. Physical examination, we found jaundice on sclera and palpabled liver 2 fingers below the costal arch. Abdominal ultrasound revealed cystic mass in right lower lobe, suggestive of hepatic cyst with inflammation of cystic head of pancreas and minimal free fluid in lumen. Abdominal CT-scan without contrast showed a choledocal cyst classified as Todani Type IV. A cyst in the bile duct was found during surgical procedure. In conclusion choledocal cyst as one of the differential diagnoses in children, which is characterized by intermittent right upper abdominal pain, jaundice and fever. Appropriate surgical measures should be undertaken to avoid complications.
Abstract: Choledocal cyst (CC) is a rare congenital cystic dilation of bile duct and can be associated with serious complications including malignancy and inflammation of the surrounding anatomy. Approximately 80% of CC is diagnosed in infants and young children in their first decade of life. Complete surgical resection is recommended in patients with choled...
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Vitamin D-Dependent Rickets Type 2: Rare Case Report
Hanady Al Haddad,
Raymonda Chahrour,
Zahra Moukhader,
Hassan Fakhredine,
Sanaa Saadeddine,
Saada Alameh
Issue:
Volume 8, Issue 3, September 2022
Pages:
173-176
Received:
20 June 2022
Accepted:
15 July 2022
Published:
4 August 2022
DOI:
10.11648/j.ajp.20220803.14
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Abstract: Vitamin D dependent rickets type 2 A (VDDR2A) is a rare autosomal recessive disorder due to end-organ resistance to 1, 25 (OH)2 vitamin D3. Clinically it can emerged by growth retardation. Rickets in the first year of life is frequently associated with alopecia, hypocalcaemia, secondary hyperparathyroidism. We report a rare case of VDDR2A in a 2 years old boy presenting with failure to thrive, developmental delay, bilateral femoral fractures and prolonged QT interval on EKG. The patient was lethargic, hypoactive, with dysmorphic features, triangular facies, defective dentition, short dysmorphic bowing lower limbs. Laboratory workup showed hypocalcemia, hypophosphatemia with high PTH level and high alkaline phosphatase level. Insuficient vitamin D2-D3 level was found. The diagnosis was confirmed on whole exome sequencing. A wide range of clinical features exists in VDDR type П. The treatment of the patient with high doses of intravenous and oral calcium, phosphorus and vitamin D gave a slow and a minimal response. In order to achieve a disease control, treatment should be started early in the course of the disease. High doses of intravenous and oral calcium infusions are needed for a good response. However, long term administration of calcium results in complications such as cardiac arrhythmia, hypercalceuria, nephrocalcinosis.
Abstract: Vitamin D dependent rickets type 2 A (VDDR2A) is a rare autosomal recessive disorder due to end-organ resistance to 1, 25 (OH)2 vitamin D3. Clinically it can emerged by growth retardation. Rickets in the first year of life is frequently associated with alopecia, hypocalcaemia, secondary hyperparathyroidism. We report a rare case of VDDR2A in a 2 ye...
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Correlation Between Method of Labor and Incidence of Neonatal Asphyxia at Wangaya General Hospital, Denpasar
I Gusti Agung Gede Narayana Tantra,
I Wayan Bikin Suryawan,
Kadek Suarca,
I Gusti Ayu Trisna Windiani
Issue:
Volume 8, Issue 3, September 2022
Pages:
177-180
Received:
10 July 2022
Accepted:
2 August 2022
Published:
10 August 2022
DOI:
10.11648/j.ajp.20220803.15
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Abstract: Indonesia is one of ten countries with the highest newborn mortality rate. Asphyxia is the second most common cause of neonatal death (27%) under low birth weight (35,3%) and is still a major health worldwide problem. The risk factor for neonatal asphyxia are grouped into four, maternal factors, infant factors, umbilical cord factors and labor factors. We aimed to determine the correlation between method of labor and incidence of neonatal asphyxia. This is a case control study which performed 37 neonates with asphyxia as the case and 37 neonates without asphyxia as the control at Wangaya Hospital from March to May 2022. Neonates who had major congenital abnormalities and born through vacuum and forceps were excluded. Assessment of neonatal asphyxia using Appearance, Pulse, Grimance, Activity, Respiration (APGAR) score. Analysis was performed using chi-square test, confident interval (CI) 95%, significant if p < 0.05. The study showed cesarean delivery method was the main risk factor for neonatal asphyxia (OR = 8,48; CI 95% = 2,83-25,44; p = 0,00). Other risk factors such as gestational age < 37 weeks, low birth weight, premature rupture of membranes, hypertension in pregnancy, and ante partum bleeding as confounding factors after being analyzed with the delivery of labor in neonates with asphyxia did not have a significant relationship (P > 0.05).
Abstract: Indonesia is one of ten countries with the highest newborn mortality rate. Asphyxia is the second most common cause of neonatal death (27%) under low birth weight (35,3%) and is still a major health worldwide problem. The risk factor for neonatal asphyxia are grouped into four, maternal factors, infant factors, umbilical cord factors and labor fact...
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Delayed Diagnosis of Congenital Hypothyroid: Concealed Problem in Developing Countries
Luh Putu Eka Sari Kresnandari,
I Made Arimbawa,
I Made Darma Yuda
Issue:
Volume 8, Issue 3, September 2022
Pages:
181-184
Received:
13 July 2022
Accepted:
5 August 2022
Published:
24 August 2022
DOI:
10.11648/j.ajp.20220803.16
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Abstract: Introduction: Screening program of congenital hypothyroidism is one of crucial evaluation in newborn period, because early detection and prompt treatment can prevent mental retardation. This screening is quite simple, and the result was revealed quickly. Beside devastating effect to central nervous system, undiagnosed congenital hypothyroidism also affect skeleton and bone maturation. Hypothyroidism constitutes about 25-30% cases of short stature in the developing nations. Case: A 6 years-old female referred to the Sanglah General Hospital in December 2021 with short stature and delayed milestone of development. She cannot walk and talk like normal children in her age. Patient performed thyroid profile and it suggest hypothyroidism with low FT4 0,42 ng/dL and high level of TSH 119,79 IU/ml. Bone age revealed delayed in bone maturation according to girls 8 months age. Patient got levothyroxine with dosage 12 mcg/kg/day (100 mcg/day) in December 2021. After one months of treatment, thyroid profile showed improvement TSHs still above normal 16,36, FT4 was normal 0,78. Conclusion: There is still cases of delay diagnosis and treatment of CH in developing country due to lack of screening program in newborn, low parental education level which led to devastating outcome for neuro muscular development.
Abstract: Introduction: Screening program of congenital hypothyroidism is one of crucial evaluation in newborn period, because early detection and prompt treatment can prevent mental retardation. This screening is quite simple, and the result was revealed quickly. Beside devastating effect to central nervous system, undiagnosed congenital hypothyroidism also...
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Evaluation of MAG3 Renal Scan for Detection of Differential Renal Function and Renal Scar in Comparison to DMSA Scan in Pediatric Population
Ferdous Ara Begum,
Jasmine Ara Haque,
Pupree Mutsuddy,
Muhammad Zahangir Alam
Issue:
Volume 8, Issue 3, September 2022
Pages:
185-190
Received:
19 December 2021
Accepted:
16 May 2022
Published:
29 August 2022
DOI:
10.11648/j.ajp.20220803.17
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Abstract: Chronic kidney disease (CKD) in children is a devastating illness with long-term effects. Globally the prevalence of CKD in childhood has been variously reported at 15 to 74.7 per million children with an increased burden in developing countries like Bangladesh. The aim of the study was to evaluate the efficacy of Tc-99m MAG3 renal scintigraphy for accurate measurement of DRF and detection of renal cortical scar in comparison to Tc-99m DMSA scan in the pediatric population. This cross-sectional observational study was carried out at the National Institute of Nuclear Medicine & Allied Sciences (NINMAS), BSMMU campus, Dhaka from July 2017 to June 2018. The study was conducted with ethical approval from Medical Research Ethics Committee (MREC). A total of 54 pediatric patients of different renal disorders were enrolled according to selection criteria and all patients underwent both Tc-99m MAG3 renal scintigraphy and Tc-99m DMSA scan by following the practiced protocol in NINMAS. A total of 54 pediatric patients (39 male and 15 female) with a mean age of 4.57 ± 4.40 years, ranging from 0.08 to 18 years had a mean height of 96.70 ± 31.70 cm and mean weight16.97±11.95 kg. The mean of DRF measured by DMSA and MAG3 was 54.22 ±20.38% and S1.47 ± 23.88% in left kidneys and 45.78 ± 20.38% and 48.51 ± 23.88% in right kidneys respectively. The Independent t-test showed the mean difference of DRF measured by two radiotracers was not statistically significant in both kidneys. There was a positive significant correlation between the two methods (Pearson correlation test, r-0.948, p-0.001 in the left kidney and r-0.958, p-0.001 in the right kidney). Our findings support the notion of promoting Tc-99m MAG3 dynamic scintigraphy as an initial nuclear medicine technique in the diagnosis of the majority of kidney illnesses by giving information on differential renal function, cortical anomalies, and drainage at the same time.
Abstract: Chronic kidney disease (CKD) in children is a devastating illness with long-term effects. Globally the prevalence of CKD in childhood has been variously reported at 15 to 74.7 per million children with an increased burden in developing countries like Bangladesh. The aim of the study was to evaluate the efficacy of Tc-99m MAG3 renal scintigraphy for...
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Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio as Predictor of Outcome in Children with Community Acquired Pneumonia
Handoyo,
Ni Putu Siadi Purniti,
I Gusti Ngurah Sanjaya Putra,
I Gusti Ngurah Made Suwarba,
I Putu Gede Karyana,
I Gusti Ayu Eka Pratiwi
Issue:
Volume 8, Issue 3, September 2022
Pages:
191-195
Received:
25 August 2022
Accepted:
7 September 2022
Published:
27 September 2022
DOI:
10.11648/j.ajp.20220803.18
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Abstract: Background: Pneumonia is the leading cause of death in children. An easy and inexpensive diagnostic tool is needed in managing the disease effectively. Neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) have role in predicting outcome of adult community acquired pneumonia but data in pediatric population is still limited. Objective: To prove that peripheral blood examination could be use as predictor of outcome in pediatric patients with community-acquired pneumonia. Methods: This is an observational analytic study with a retrospective case control design, to know value of neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) as predictor of outcome in pediatric community-acquired pneumonia. The study was conducted using medical record data of hospitalized patient in the Pediatric Ward Prof. Dr. I.G.N.G Ngoerah Hospital from November 2020 to December 2021 with the consecutive sampling method. Data analysis was carried out using receiver operator characteristic curve to find the optimal cut-off value then continued with chi-square analysis. The significance level (α) of this study was set at a probability value (p) of less than 0.05. Results: This study involved 104 subjects, divided equally into survive and deceased groups. After adjustment of age, gender, nutritional status, and result of microbiology examination, increase in NLR value ≥ 2.47 had 67.98 times risk of death (95% CI 17.18-268.95; p < 0.001) with 86.5% sensitivity and 90.4% specificity, an increase in MLR value ≥ 0.32 had 11.96 times risk of death (95% CI 4.5-31.72; p < 0.001) with 75% sensitivity and 80.8% specificity, and an increase in PLR value ≥ 121.07 had 8.41 times risk of death (95% CI 3.15-22.49; p < 0.001) with 65.4% sensitivity and 82.7% specificity. Conclusion: The increase in neutrophil lymphocytes, monocyte lymphocytes, and platelet lymphocytes ratio were predictor of mortality in pediatric community-acquired pneumonia.
Abstract: Background: Pneumonia is the leading cause of death in children. An easy and inexpensive diagnostic tool is needed in managing the disease effectively. Neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) have role in predicting outcome of adult community acquired pneumonia but data in pediatric population ...
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