bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role Of Information And Communication Technologies In The Global Environment
Authors:   Assistant Of Professor, Tashkent State Pedagogical University, Uzbekistan, Kholdarvovna Tillavoldieva Matluba
Published: May 2021

In this article, the rapid development of communication and data transmission tools such as the Internet, television, film, radio, video, mobile phone, slides and rates reflecting various data, the formation of information culture and the awareness and elimination of the problems of information security of the growing generation are considered to be one of the pressing issues of today.
Qui « décroche » de l’université ? Le cas des étudiants de la région Aquitaine (France)
Authors:   Université de Bordeaux, ZAFFRAN Joël , AIGLE Maud ,   Université de Bordeaux
Published: May 2021

La lutte contre le décrochage à l’université recueille un large consensus auprès des différents acteurs politiques et universitaires. Quels que soient les référentiels, la nécessité d’un changement des conditions d’accompagnement des étudiants est souvent rappelée, avec à l’appui le taux de réussite en fin de 1re année de licence qui reste insuffisant et les abandons sont en nombre importants. Or, la manière de présenter publiquement le problème mélange les situations d’abandon définitif des études, de réorientation et d’interruption provisoire des études. Qui décroche réellement à l’université et combien sont-ils vraiment ? Notre communication a deux objectifs. Le premier objectif est de présenter les résultats d’une vaste enquête par questionnaire menée à l’échelle d’une région auprès des sortants sans diplôme. Au regard de ces résultats, le second objectif est de pointer les facteurs explicatifs du décrochage à l’université mais surtout de souligner la nature processuelle du problème.
Les Difficultés d’adaptation psychosociale et les aptitudes intellectuelles chez les élèves à risque d’échec scolaire
Authors:   Université Mohammed V, Rabat, ECHARGHAOUI Mohammed
Published: May 2021

Cette étude vise à déterminer les difficultés d’adaptation psychosociale, d’identifier les aptitudes intellectuelles chez les élèves à risque d’échec scolaire et de chercher profondément les facteurs d’adaptation psychosociale ayant un pouvoir discriminatif. L’échantillon se formait de certains élèves au niveau secondaire, présentant des risques d’échec scolaire. On s’est servi de six subtests de la Batterie NV7. A l’issue d’un ensemble d’analyses, on a constaté que la majorité des élèves à risque d’échec scolaire présente de moyennes aptitudes intellectuelles qui diffèrent selon le sexe et le niveau scolaire. Ces derniers ont des difficultés psychosociales au niveau du sentiment de compétence, de la volonté d’apprendre en français, de l’avantage à décrocher, du climat éducatif et de l’estime de soi. La volonté d'apprendre, le sentiment de compétence en français & en mathématiques, et l’attrait envers l'école influencent leur adaptation.
Chocs et survie dans l’éducation : le cas du Sénégal
Authors:   UCAD, Dakar, SANE Malick
Published: May 2021

Les causes de l’échec scolaire dans les pays en développement ne sont pas uniquement liées au dysfonctionnement du système éducatif mais pourraient être associées à la qualité de vie environnementale et familiale dans laquelle évolue l’enfant. Cette étude est basée sur les modèles économétriques de durée. L’échantillon est composé d’enfants âgés entre 5 et 15 ans vivant dans des ménages ayant subi des chocs. Les résultats basés sur une analyse non paramétrique et ceux portant sur l’analyse paramétrique convergent vers les mêmes conclusions. Il ressort en effet de l’étude que, conditionnellement aux autres caractéristiques socio-économiques, les chocs négatifs diminuent les chances de survie à l’échec scolaire des enfants tandis que ceux positifs les augmentent. On note aussi que les autres caractéristiques socio-économiques (niveau de vie, niveau d’instruction, genre, localisation) impactent sur l’échec scolaire mais de manière différente. C’est pourquoi l’élaboration de mécanismes de réduction de la vulnérabilité des ménages est souhaitable. Cela peut passer par la mise en place de filets sociaux de sécurité par l'État ou par la promotion de systèmes de micro-assurance par les institutions de microfinance déjà présentes dans de nombreux pays.
Les Pathologies psychoaffectives dans l´équation de l´abandon scolaire
Authors:   Université Hassan II Casablanca, SIBENALI Mohammed Yassine , EZZOUIRCHI Chada ,   Université Ibn Tofail, Kénitra
Published: May 2021

Cette recherche se focalisera sur un des problèmes dont souffre l’enseignement au Maroc, celui du décrochage scolaire. Ce dernier constitue un fragment qui manque au puzzle éducatif marocain. Depuis ces dernières années, les raisons du décrochage scolaire sont multiples et nécessitent un souffle de longue haleine. Plusieurs initiatives académiques et associatives sont proposées mais jugées insuffisantes vue l´ampleur et la vitesse vertigineuse que commence à prendre ce phénomène.
Street Food Safety, Types and Microbiological Quality in Ethiopia: A Critical Review
Authors: Teferi SC
Published: May 2021

Street food is food obtained from a street side vendor, often from a makeshift or portable stall and it feeds millions of people daily with a wide variety of foods that are relatively cheap and easily accessible. Street food is intimately connected with take-out, junk food, snacks, and fast foods but it is not protected against insects, dust etc; which may harbor foodborne pathogens. Pathogens present in street vended foods come from different sources and practices, such as, improper food handling, improper waste disposal, contaminated water and improper storage temperature and reheating. Food borne illnesses are defined as diseases, usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food. Like other African and World countries there are many food vendors in Ethiopia where they sell both raw and cooked food items along the streets of different cities but it is far more unhygienic due to several reasons. So the objective of this review paper was to assess the existing research about street food safety, types, hygiene knowledge, and preparation and forward suggestion for stakeholders/policy makers to bridge the gap. Majority of street vended foods in Ethiopia are contaminated by bacteria like Salmonella, S aureus, E coli so the Government should intervene and solve the issue before it is too late.
COVID-19 Rapid Guideline - Organisation and Management in Low Resource Countries
Authors: Vancheeswaran Rama , Barlow Andy , Pyae P.K. , O'Neill A , Vancheeswaran V , Mitchell H , Cama R , Van der Watt M
Published: May 2021

This guideline covers the wide range of global efforts to counter the COVID-19 pandemic, aiming to outline options for the delivery of care.
In noting the wide variation in testing, triage, management and vaccination (summarised in Table 1.1–5 ), we seek to identify opportunities for rapid transformational change particularly in countries with stretched resources and less well-developed healthcare systems.
The infographics should enable easy translation, education, and dissemination among both the healthcare population and the public. It has been divided into organisational delivery, treatment, and vaccination.
Measuring Physical Function in Psoriatic Arthritis: Comparing the Multidimensional Health Assessment Questionnaire to the Health Assessment Questionnaire–Disability Index
Authors: Ye Weiyu , Hackett Simon , Vandevelde Claire , Twigg Sarah , Helliwell Philip S. , Coates Laura C.
Published: May 2021

Objective

To compare physical function scales of the Multidimensional Health Assessment Questionnaire (MDHAQ) with that of the Health Assessment Questionnaire–Disability Index (HAQ-DI) in patients with psoriatic arthritis (PsA), and to examine whether either questionnaire is less prone to “floor effects.”

Methods

Data were collected prospectively from 2018 to 2019 across 3 UK hospitals. All patients completed physical function scales within the MDHAQ and HAQ-DI in a single clinic visit. Agreement was assessed using medians and the Bland-Altman method. Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability.

Results

Two hundred ten patients completed the clinic visit; 1 withdrew consent. Thus, 209 were analyzed. Sixty percent were male, with mean age of 51.7 years and median disease duration of 7 years. In clinic, median MDHAQ and HAQ-DI including/excluding aids scores were 0.30, 0.50, and 0.50 respectively. Although the median score for HAQ-DI was higher than for MDHAQ, the difference between the 2 scores was mostly within 1.96 SDs from the mean, suggesting good agreement. The ICCs demonstrated excellent test-retest reliability for both the MDHAQ and HAQ-DI. Similar numbers of patients scored 0 on the MDHAQ and HAQ-DI including/excluding aids (48, 47, and 49, respectively). Using a score of ≤ 0.5 as a cutoff for minor functional impairment, 23 patients had a MDHAQ ≤ 0.5 when their HAQ-DI including aids was > 0.5. Conversely, 4 patients had a MDHAQ > 0.5 when the HAQ-DI including aids was ≤ 0.5.

Conclusion

Both the MDHAQ and HAQ-DI appear to be similar in detecting floor effects in patients with PsA.
Discontinuation of Colchicine Therapy in Children With Familial Mediterranean Fever
Authors: Aviel Yonatan Butbul , Rawan Silman , Fahoum Shafe , Wexler Isaiah , Berkun Yackov
Published: May 2021

Objective

Colchicine has been considered a lifelong therapy for familial Mediterranean fever (FMF). Recent studies describe patients who discontinued colchicine, but there is a lack of data pertaining to predictors of success. The aims of our study were to describe a cohort of pediatric patients with FMF who discontinued colchicine therapy, and to identify factors predicting successful termination of colchicine.

Methods

This study describes a cohort of pediatric patients with FMF who discontinued colchicine therapy following a relatively prolonged attack-free period (> 6 months), and identifies factors predicting successful termination. Data collected included demographic, clinical, and laboratory characteristics of children diagnosed with FMF aged < 16 years who underwent a trial of colchicine discontinuation. Data from patients who successfully ceased colchicine therapy were compared to those of patients who relapsed.

Results

Of 571 patients with FMF, 59 (10.3%) discontinued colchicine therapy. The average attack-free period before enrollment was 0.97 ± 1.4 years. Follow-up after ceasing colchicine was 5.0 ± 3.05 years, during which time 11 (20%) patients had an attack. The most common symptoms were fever (100%) and abdominal pain (80%). For those failing discontinuation, colchicine was restarted within 1.3 years (range 0.3–5.0, median 0.7 yrs). A longer attack-free period prior to colchicine discontinuation predicted success. Myalgia and arthritis prior to colchicine cessation were more common among children who required renewal of colchicine.

Conclusion

Cessation of colchicine therapy should be considered following prolonged remission in a select group of patients. Patients with arthritis or myalgia are more likely to have an attack after ceasing colchicine therapy.
Gastrointestinal Adverse Drug Reaction Profile of Etanercept: Real-world Data From Patients and Healthcare Professionals
Authors: van Lint Jette A. , Jessurun Naomi T. , Tas Sander W. , van den Bemt Bart J.F. , Nurmohamed Michael T. , van Doorn Martijn B.A. , Spuls Phyllis I. , van Tubergen Astrid M. , ten Klooster Peter M. , van Puijenbroek Eugene P. , Hoentjen Frank , Vonkeman Harald E.
Published: May 2021

Objective

We aimed to describe the nature and frequency of gastrointestinal adverse drug reactions (GI-ADRs) of etanercept (ETN) using patient-reported and healthcare professional (HCP)-registered data and compared this frequency with the GI-ADR frequency of the widely used tumor necrosis factor-α inhibitor adalimumab (ADA).

Methods

Reported GI-ADRs of ETN for rheumatic diseases were collected from the Dutch Biologic Monitor and DREAM registries. We described the clinical course of GI-ADRs and compared the frequency with ADA in both data sources using Fisher exact test.

Results

Out of 416 patients using ETN for inflammatory rheumatic diseases in the Dutch Biologic Monitor, 25 (6%) patients reported 36 GI-ADRs. In the DREAM registries 11 GI-ADRs were registered for 9 patients (2.3%), out of 399 patients using ETN, with an incidence of 7.1 per 1000 patient-years. Most GI-ADRs consisted of diarrhea, nausea, and abdominal pain. GI-ADRs led to ETN discontinuation in 1 patient (4%) and dose adjustment in 4 (16%) in the Dutch Biologic Monitor. Eight GI-ADRs (73%) led to ETN discontinuation in the DREAM registries. The frequency of GI-ADRs of ETN did not significantly differ from GI-ADRs of ADA in both data sources (Dutch Biologic Monitor: ETN 8.7% vs ADA 5.3%,P= 0.07; DREAM: ETN 2.8% vs ADA 4.7%,P= 0.16).

Conclusion

Most GI-ADRs associated with ETN concerned gastrointestinal symptoms. These ADRs may lead to dose adjustment or ETN discontinuation. The frequency of ETN-associated GI-ADRs was comparable to the frequency of ADA-associated GI-ADRs. Knowledge about these previously unknown ADRs can facilitate early recognition and improve patient communication.
Systematic Review and Metaanalysis of the Reproducibility of Patient Self-reported Joint Counts in Rheumatoid Arthritis
Authors: Rampes Sanketh , Patel Vishit , Bosworth Ailsa , Jacklin Clare , Nagra Deepak , Yates Mark , Norton Sam , Galloway James B.
Published: May 2021

Objective

To assess the reproducibility of patient-reported tender (TJCs) and swollen joint counts (SJCs) of patients with rheumatoid arthritis (RA) compared to trained clinicians.

Methods

We conducted a systematic literature review and metaanalysis of studies comparing patient-reported TJCs and/or SJCs to clinician counts in patients with RA. We calculated pooled summary estimates for correlation. Agreement was compared using a Bland-Altman approach.

Results

Fourteen studies were included in the metaanalysis. There were strong correlations between clinician and patient TJCs (0.78, 95% CI 0.76–0.80), and clinician and patient SJCs (0.59, 95% CI 0.54–0.63). TJCs had good reliability, ranging from 0.51 to 0.85. SJCs had moderate reliability, ranging from 0.28 to 0.77. Agreement for TJCs reduced for higher TJC values, suggesting a positive bias for self-reported TJCs, which was not observed for SJCs.

Conclusion

Our metaanalysis has identified a strong correlation between patient- and clinician-reported TJCs, and a moderate correlation for SJCs. Patient-reported joint counts may be suitable for use in annual review for patients in remission and in monitoring treatment response for patients with RA. However, they are likely not appropriate for decisions on commencement of biologics. Further research is needed to identify patient groups in which patient-reported joint counts are unsuitable.
Patient Perspectives on Outcome Domains of Medication Adherence Trials in Inflammatory Arthritis: An International OMERACT Focus Group Study
Authors: Bekker Charlotte L. , Bossina Sacha , de Vera Mary A. , Bartlett Susan J. , de Wit Maarten , March Lyn , Shea Beverley , Evans Vicki , Richards Dawn , Tong Allison , Tugwell Peter , Tymms Kathleen , Scholte-Voshaar Marieke , Kelly Ayano , van den Bemt Bart J.F.
Published: May 2021

Objective

To describe the perspectives of patients with inflammatory arthritis (IA) on outcome domains of trials evaluating medication adherence interventions.

Methods

Adult patients (≥ 18 yrs) with IA taking disease-modifying antirheumatic drugs from centers across Australia, Canada, and the Netherlands participated in 6 focus groups to discuss outcome domains that they consider important when participating in medication adherence trials. We analyzed the transcripts using inductive thematic analysis.

Results

Of the 38 participants, 23 (61%) had rheumatoid arthritis and 21 (55%) were female. The mean age was 57.3 ± (SD 15.0) years. Improved outcome domains that patients wanted from participating in an adherence trial were categorized into 5 types: medication adherence, adherence-related factors (supporting adherence; e.g., medication knowledge), pathophysiology (e.g., physical functioning), life impact (e.g., ability to work), and economic impact (e.g., productivity loss). Three overarching themes reflecting why these outcome domains matter to patients were identified: how taking medications could improve patients’ emotional and physical fitness to maintain their social function; how improving knowledge and confidence in self-management increases patients’ trust and motivation to take medications as agreed with minimal risk of harms; and how respect and reassurance, reflecting health care that values patients’ opinions and is sensitive to patients’ individual goals, could improve medication-taking behavior.

Conclusion

Patients value various outcome domains related to their overall well-being, confidence in medication use, and patient–healthcare provider relationships to be evaluated in future adherence trials.
Systematic Analysis of the Literature in Search of Defining Systemic Sclerosis Subsets
Authors: Nevskaya Tatiana , Pope Janet E. , Turk Matthew A. , Shu Jenny , Marquardt April , van den Hoogen Frank , Khanna Dinesh , Fransen Jaap , Matucci-Cerinic Marco , Baron Murray , Denton Christopher P. , Johnson Sindhu R.
Published: May 2021

Objective

Systemic sclerosis (SSc) is a multisystem disease with heterogeneity in presentation and prognosis.

An international collaboration to develop new SSc subset criteria is underway. Our objectives were to identify systems of SSc subset classification and synthesize novel concepts to inform development of new criteria.

Methods

Medline, Cochrane MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Web of Science were searched from their inceptions to December 2019 for studies related to SSc subclassification, limited to humans and without language or sample size restrictions.

Results

Of 5686 citations, 102 studies reported original data on SSc subsets. Subset classification systems relied on extent of skin involvement and/or SSc-specific autoantibodies (n = 61), nailfold capillary patterns (n = 29), and molecular, genomic, and cellular patterns (n = 12). While some systems of subset classification confer prognostic value for clinical phenotype, severity, and mortality, only subsetting by gene expression signatures in tissue samples has been associated with response to therapy.

Conclusion

Subsetting on extent of skin involvement remains important. Novel disease attributes including SSc-specific autoantibodies, nailfold capillary patterns, and tissue gene expression signatures have been proposed as innovative means of SSc subsetting.
Majeed Syndrome: Five Cases With Novel Mutations From Unrelated Families in India With a Review of Literature
Authors: Chavan Pallavi Pimpale , Aksentijevich Ivona , Daftary Aditya , Panwala Hiren , Khemani Chetna , Khan Archana , Khubchandani Raju
Published: May 2021

Objective

Majeed syndrome (MJS) is an autosomal recessive, systemic autoinflammatory disease (SAID) caused by biallelic loss-of-function variants in theLPIN2gene. It is characterized by early-onset chronic recurrent multifocal osteomyelitis (CRMO), dyserythropoietic anemia, and neutrophilic dermatosis. We analyzed a cohort of uncharacterized Indian patients for pathogenic variants inLPIN2and other genes associated with SAIDs.

Methods

We performed whole-exome sequencing (WES) for 1 patient and next-generation sequencing (NGS) targeted gene panel for SAIDs in 3 patients. One patient was a referral from neurology after clinical exome sequencing identified a novel variant inLPIN2. We reviewed the literature for all published studies of mutation-positive MJS patients and have summarized their clinical features and disease-causing variants.

Results

We describe the largest series of patients with MJS outside of the Middle East. All 5 patients are homozygous for novel, possibly pathogenic variants in theLPIN2gene. Two of these variants are missense substitutions, and 3 are predicted to alter transcript splicing and create a truncated protein. In addition to the classical features of CRMO and anemia, patients exhibited previously unreported features, including abdominal pain, recurrent diarrhea/ear discharge, and erythema nodosum.

Conclusion

Patients with MJS may present initially to different specialists, and thus it is important to create awareness in the medical community. In India, consanguinity is a common sociocultural factor in many ethnic communities and an abbreviated NGS gene panel for autoinflammatory diseases should include MJS. The unavailability of interleukin 1 inhibitors in some countries poses a treatment challenge.
Supporting Equity in Rheumatoid Arthritis Outcomes in Canada: Population-specific Factors in Patient-centered Care
Authors: Pianarosa Emilie , Hazlewood Glen S. , Thomas Megan , Hsiao Ralph , Barnabe Cheryl
Published: May 2021

Objective

Health equity considerations have not been incorporated into prior Canadian Rheumatology Association guidelines. Our objective was to identify the challenges and possible solutions to mitigate threats to health equity in rheumatoid arthritis (RA) care in Canada.

Methods

A consultation process informed selection of priority populations, determined to be rural and remote, Indigenous, elderly with frailty, first-generation immigrant and refugee, low income and vulnerably housed, and diverse gender and sex populations. Semistructured interviews were completed with patients with lived experience, healthcare providers, and equity-oriented researchers. These interviews probed on population factors, initial and ongoing healthcare access issues, and therapeutic considerations influencing RA care. Known or proposed solutions to mitigate inequities during implementation of service models for the population group were requested. The research team used a phenomenological thematic analysis model and mapped the data into a logic model. Solutions applicable to several population groups were proposed.

Results

Thirty-five interviews were completed to identify realities for each population in accessing RA care. Five themes emerged as primary solutions to population-based inequities, including actively improving the patient–practitioner relationship, increasing accessibility and coordination of care through alternative models of care, upholding autonomy in treatment selection while actively addressing logistical barriers and individualized therapy needs, collaborating with health supports valued by the patient, and being advocates for policy change and health system restructuring to ensure appropriate resource redistribution.

Conclusion

The challenges for populations facing inequities in rheumatology care and promising solutions should inform guideline development and implementation, policy change, and health system restructuring.
Measuring oxygen saturation and pulse rate in dairy cows before and after machine milking using a low-cost pulse oximeter
Authors: Calcante Aldo , Tangorra Francesco M.
Published: May 2021

The present study was aimed at measuring the haemoglobin oxygen saturation and the pulse rate on dairy cow teats before and after milking, using a bespoke low-cost pulse oximeter. The pulse oximeter was tested in a three-day field test involving 18 Holstein Friesian cows raised in a commercial farm located in Northern Italy. The results highlighted a significant difference both in haemoglobin oxygen saturation (SpO2) and pulse rate before and after milking in the entire sample of animals. By dividing the sample according to the milking time (fast <8 min and slow >8 min), a significant difference between fast and slow cows was observed for SpO2, whilst no difference was identified in relation to their lactation stage [<70 days in milking (DIM) and 71-140 DIM]. As to the pulse rate, milking time and lactation stage were not significantly different. This confirms that machine milking can create stress to the teat causing tissue circulatory impairment and pulse oximetry could be useful for detecting machine milking-induced alterations of teats. In the future, the pulse oximeter could be used as part of a milking machine monitoring system in order to change operating parameters to minimize the mechanical stress on the teats.
Elevated Liver Enzymes in Association with Vasopressin Use in a Neonate
Authors: Manzar Shabih
Published: May 2021

Vasopressin has been used in neonates for refractory hypotension. Elevation in liver enzymes due to mesenteric mucosal hypoperfusion has been associated with the use of vasopressin in adults. We present a case of a neonate that develop elevated liver enzymes in association with vasopressin use and migration of umbilical venous catheter.
A Case of Milky Serum in Neonate with Rare Mutation of Lipoprotein Lipase
Authors: Shreeshruthi B. , Peter R. , Saravanan G. , Subburaman V. S.
Published: May 2021

Acute pancreatitis is one of the dreaded complications of hypertriglyceridemia. According to the literature, 7% of cases of acute pancreatitis are due to hypertriglyceridemia or chylomicronemia associated with genetic defects in the lipid metabolism. Here, we report a 17-day-old baby, who presented as a case of necrotizing enterocolitis. Incidental phlebotomy showed pink creamy serum. This highly suggestive of hypertriglyceridemia, lipid profile study was done that confirmed elevated serum triglyceride (TG) and cholesterol levels with decreased high-density lipoprotein. To minimize the risk of pancreatitis, exchange transfusion, a procedure widely performed in neonatology was sought to, that dramatically reduced the serum TG and cholesterol levels. Baby was then started on skimmed milk, fenofibrate, and medium-chain TGs oil to maintain the plasma TG levels low. Genetic analysis confirmed the diagnosis of type I hyperlipoproteinemia/familial combined hyperlipidemia-3. This report emphasizes the importance of suspecting hypertriglyceridemia on witnessing milky serum so that early intervention with novel modalities such as exchange transfusion can prevent complications such as acute pancreatitis.
Reducing Medication Errors on a Busy Tertiary Neonatal Intensive Care Unit Using a Quality Improvement Approach
Authors: Ibrahim Chokkiyil Ponnambath Hafis , Ofoegbu Bibian , Yahya Lamia , Catroon Khlood , Al Masri Duaa Adel , Saliba Adeline , Ghassa Lina
Published: May 2021

Objectives:

Due to a high rate of reported medication errors on our neonatal intensive care unit (NICU), a quality improvement project was undertaken to tackle the problem in 2015. The steps included the development of a customized formulary, which was aligned to the electronic prescribing system and the smart pump libraries. The incidence of medication errors after serial introduction of the interventions was studied.

Methods:

Data on medication errors were extracted from the online incident reporting system. Additional data were derived from the pharmacy database. Trend on errors for the whole year was analyzed. Results: The medication error rate fell from 25.7/1000 to 6.7/1000 patient-days with the implementation of the project which was sustained even after the project implementation was complete. There was a statistically significant reduction in the rate of medication errors over the course of the year.

Conclusions:

Medication errors are common in neonatal care. A quality improvement approach with enhancements of existing systems significantly reduced the reported medication errors on the local NICU.
Jejunostomy for Enteral Trophic Feeding in the Management of Apple-Peel Intestinal Atresia
Authors: Garcia Smith Natalie Isabel , Casano Carmen Jovani , Comella Beatriz Pemartin , Muñoz Marta Olivares
Published: May 2021

Apple-peel (or Type IIIb) is an unusual and severe type of intestinal atresia that has generally been treated with anastomosis, entailing considerable morbidity. The aim of this case report is to present an alternative management option that allows intestinal adaptation before performing the anastomosis. We present a case of apple-peel atresia, born at 27 weeks, which during surgery presented a large discordance between the duodenum and the atretic segment. A jejunostomy of the distal atretic bowel was performed to initiate enteral trophic feeding and stimulate its growth. At 2 months of life, both anastomotic ends were similar in caliber and a side-to-side anastomosis was performed. Jejunostomy is an alternative management option that allows to perform a deferred anastomosis in better conditions.
Experiences and Outcomes of Frenotomy in Children with Ankyloglossia in Multiple Tertiary Centers in Saudi Arabia
Authors: Bawazir Osama A. , Bawazir Abdullah O. , Bawazir Razan O. , Bawazir Faisal Ahmed , Halabi Nawaf F.
Published: May 2021

Aims:

The aim of the study was to examine the experiences and outcomes of frenotomy treatment in neonates and children with ankyloglossia and to explore any subsequent complications.

Patients and Methods:

This is a retrospective, cross-sectional study of all pediatric cases of ankyloglossia that initially underwent frenotomy over a period of 5 years, in 2015–2020, across a number of departments in three tertiary centers in Jeddah, Saudi Arabia.

Results:

The most common indications were feeding difficulty in infants under 4 months and speech difficulty in children over 4 months. Following frenotomy, improvements were observed in symptomatic (96%) and asymptomatic (≈70%) children. Overall complications in the frenotomy procedure, including any minor bleeding, were found to be minimal.

Conclusion:

Ankyloglossia is a common disorder, but its effects on feeding and speaking are difficult to determine objectively, owing to the complexity of individual cases. Most of the babies in the present study improved following frenotomy, which is a simple, time-efficient, low-cost, and safe procedure.
Ventral Chest Tube Placement in a Neonate for Pneumothorax
Authors: Wahid Fazal Nouman
Published: May 2021

We present the case of a newborn baby who has developed bilateral pneumothorax treated with ventral chest tube placement after the failure of resolution of the pneumothorax by traditional lateral approach multiple times. An old but yet forgotten approach will be discussed.
Family-Centered Lactation Counseling and Breastfeeding in Preterm Infants upon Neonatal Intensive Care Discharge
Authors: Ongun Hakan , Demir Meltem
Published: May 2021

Background:

There is great variability in breastfeeding implications upon neonatal intensive care unit discharge for preterm infants. Aims and Objectives: To examine the breastfeeding rates and the impact of lactation-counseling on the nutrition following hospital discharge in preterm infants.

Materials and Methods:

A three-page survey was applied to the families of infants of gestational age ≤34 weeks who were hospitalized between 2016-2018. Exclusion criteria were family reluctance to consent, foster-care placement, acquiring enteral feeding by orogastric tube/gastrostomy. The group categorization was based on lactation-counselling that involved both parents and elderly relatives who would assist the mother at neonatal care. Statistics were performed using SPSS-22 for covariates of neonatal intensive care interventions and post-discharge nutrition.

Results:

Exclusive breastfeeding was 49.2% at hospital-discharge and declined to 31.3% at six months. Early introduction of complementary foods was 51.1%. Total duration of breastfeeding was 7.38±3.98 months. Lactation-counseling prolonged breastfeeding duration to 8.47±3.87 months. The program presented the highest odds of extending breastfeeding interventions beyond six months (OR: 2.183, 95% CI: 1.354–3.520). It favored the outcomes by reducing the introduction of formulas and complementary foods before six months (P = 0.044, P = 0.018). The physical contribution of the father towards nutrition was the most significant benefit claimed by the participants. (71.6 versus 51.8%).

Conclusion:

Family-centered peer lactation-counseling by the medical staff and increasing awareness for infant nutrition are promising local strategies in reaching the goals of national nutrition policies guided by the international recommendations in preterm infants.
Outcome of Nonurinary Surgical Malformations Predicted by Fetal Abdominal Signs on Prenatal Ultrasound
Authors: Gupta Amit , Ezung Leonard J. , Kumar Manisha , Kumar Vipan , Choudhury Subhasis Roy , Yadav Partap S.
Published: May 2021

Aim:

The aim of our study was to study the outcome of “nonurinary” surgical malformations predicted by fetal abdominal signs on prenatal ultrasound (US).

Methods:

This prospective observational study was done over a 3-year period.

Results:

Out of 66 cases, 15 different malformations were detected. The accuracy of prenatal US was 83.3%. There were four still births, two medical termination of pregnancy, and sixty live births (91%). Postnatal surgery was necessary in 35 neonates (62.5%) with postoperative survival of 71.4%. Sixteen neonates (26.7%), 7 with normal postnatal US and 9 asymptomatic lesions, were managed conservatively. Overall 1-year survival rate of fetuses was 62.1%. The most common malformations confirmed postnatally were duodenal atresia (n = 14, 23.3%), followed by gastroschisis (n = 9; 15%), esophageal atresia (n = 8; 13.3%), meconium peritonitis (n = 4; 6.7%), and ovarian cyst (n = 4; 6.7%). Prematurity (n = 34; 56.7%) and low birth weight (n = 44; 66.7%) had no significant effect on survival due to in utero transfer to tertiary care. Salient factors adversely affecting the survival were: (1) type of anomaly-omphalocele major and fetal ascites (FA) had no survivors, (2) postoperative complications, and (3) associated cardiac anomalies. It was also notable that, among fetal signs of meconium peritonitis, isolated intra-abdominal calcification had a good prognosis with 75% survival, whereas FA had no survivors.

Conclusions:

Results of this study will be helpful in realistic prognostication and postnatal management of these anomalies in the appropriate hospital setting.
Paracetamol for Closure of Patent Ductus Arteriosus in Preterm Babies Born Before 32-Week Gestational Age
Authors: Mahmoud Nagwa Sabry , Asklany Hany
Published: May 2021

Background:

It remains unclear which treatment approach is most advantageous for closure of patent ductus arteriosus (PDA) in preterm infants. Despite the presence of previous trials and meta-analysis, a correct and univocal strategy for closure of PDA is still under debate. Till now, standard medical treatment for PDA closure has been indomethacin/ibuprofen, percutaneous transcatheter closure, or surgical ligation. Up to date, new strategies have been reported with paracetamol. The aim of this study was to present our experience with intravenous (IV) and oral paracetamol for closing PDA in preterm neonates born before 32-week gestational age (GA).

Patients and Methods:

We conducted a prospective study in a neonatal intensive care unit (NICU) from a tertiary hospital in Minia University; Egypt. Eighty-seven preterm neonates born before 32-week GA with hemodynamically significant PDA (hsPDA) were enrolled. They received 15 mg/kg/6 h for 5 days IV or oral paracetamol for ductal closure. Our NICU guidelines before the current study state that only hsPDA is treated with oral ibuprofen based on the decision of the neonatologist after discussion with pediatric cardiologist. The study aims to vary the practice to use IV or oral paracetamol instead of ibuprofen to avoid side effects of nonsteroidal drugs in preterm babies.

Results:

During the study period, 140 babies <32 weeks admitted to the NICU assessed for eligibility to the study, 87 of them received IV or oral paracetamol for the treatment of hsPDA for a total of 5 days. Forty-five babies received IV paracetamol, while 42 received oral form with closure rate of 82.22% and 80.95%, respectively. Successful closure on paracetamol was achieved in 71 of 87 babies (81.6%).

Conclusion:

This study concluded that paracetamol is not only an alternative treatment in closing PDA but also may be the treatment of choice in future.
Efficacy of Expressed Breast Milk Alone or in Combination with Paracetamol in Reducing Pain during ROP Screening
Authors: Naik Anjali , D'Lima Annely , Sreekumar Kavita , Silveira Maria Piedade
Published: May 2021

Introduction:

Retinopathy of prematurity (ROP) has been widely acknowledged to be the primary cause of preventable childhood blindness in developing countries. However, the procedure for screening is extremely painful. In this study, we attempted to relieve the pain experienced by these babies using breast milk alone or in combination with oral paracetamol.

Materials and Methods:

A total of 120 preterm neonates were randomized into three groups: (Group A – control group = 40, Group B – breast milk group = 40, and Group C – oral paracetamol + breast milk = 40). Group B received 2 ml expressed breast milk (EBM) through a sterile syringe orally 2 min prior to procedure, Group C received syrup paracetamol, 15 mg/kg 30 min prior to procedure and EBM as in Group B. Pain experienced was measured by the premature infant pain profile (PIPP) score 20 s prior, during and 2 min after procedure. All procedures were video recorded. The video recorder and analyzer were both blinded to the intervention.

Results:

PIPP scores before the procedure (PIPP 1) in Groups A, B, and C were 4.09 ± 2.44, 3.25 ± 1.71, and 3.45 ± 2.20. Postprocedure PIPP score (PIPP 2) increased to 15.74 ± 2.42 in Group A, 15.44 ± 2.05 in Group B, and 15.83 ± 1.36 in Group C. There was no significant statistical difference in pain scores in the intervention groups (Groups B and C) compared to the control group (Group A),P= 0.724. PIPP scores recorded postprocedure in Groups A, B, and C were, 7.72 ± 3.43, 6.87 ± 3.46, and 7.85 ± 3.37 indicating residual pain.

Conclusion:

The procedure of ROP screening causes significant pain, with persistence of residual pain in premature neonates. However, there was no statistical difference in the pain scores noted in the intervention Groups B and C in comparison to the control Group A
An Observational Prospective Study to Compare Transcutaneous Bilirubin with Serum Bilirubin in Preterm Newborn Requiring Phototherapy
Authors: Sardar Syamal , Sarkar Nirmalya , Ghosh Moumita , Pal Somnath
Published: May 2021

Background:

Transcutaneous bilirubin is used as a screening tool before starting phototherapy in preterm newborn. However, there is conflicting evidence regarding its utility after starting phototherapy. There is also doubt regarding the best site of measurement.

Objective:

The objective was to analyze the association between transcutaneous bilirubin and serum bilirubin in Indian preterm newborns at different sites before, during, and after phototherapy.

Methods:

This prospective observational study was conducted in a tertiary care neonatal unit of eastern India from May 2019 to April 2020.

Participants:

The study participants were 90 preterm newborns admitted for phototherapy within the first 7 days of life.

Intervention:

Transcutaneous bilirubin was assessed by Draeger JM-105 at the covered areas of the sternum and forehead and serum bilirubin was assessed by the Diazo method within 30 min of each other. Bilirubin assessment was done before starting phototherapy and then repeated every 12 h till 24 h postphototherapy.

Outcome:

To determine the correlation and agreement between serum bilirubin and transcutaneous bilirubin in preterm newborns before, during and after phototherapy.

Results:

Median gestational age and mean birth weight of the enrolled infants were 33.5 weeks and 1920 g, respectively. Transcutaneous bilirubin from sternum demonstrated good correlation with serum bilirubin before (r = 0.856), during (r = 0.723 at 24 h), and after phototherapy (r = 0.801 at 24 h postphototherapy). Measurements from the forehead showed better correlation with serum bilirubin compared to the sternum (r = 0.865 before, 0.732 during, 0.814 after phototherapy). At both sites, correlation worsened with phototherapy but improved gradually in the postphototherapy period. Bland–Altman analysis revealed wide upper limit of agreement between transcutaneous bilirubin and serum bilirubin at both sites and all points of time, suggesting a transcutaneous device significantly overestimated serum bilirubin.

Conclusion:

There was good correlation but poor agreement between transcutaneous bilirubin and serum bilirubin in Indian preterm newborns irrespective of timing and site of measurement.
Comparison between Suction Rectal Biopsy and Full-Thickness Rectal Biopsy in the Diagnosis of Hirschsprung's Disease
Authors: Redkar Rajeev , Chigicherla Swathi , Tewari Shruti , Sharma Rahul Deo
Published: May 2021

Aim:

The aim of this study is to compare suction rectal biopsy (SRB) with full-thickness rectal biopsy (FTRB) in suspected cases of Hirschsprung's disease (HD).

Materials and Methods:

Between 2014 and 2018, we enrolled 41 consecutive children with suspected HD. We analyzed demographics, sex, age, clinical symptoms, radiological images, and biopsy reports. All the children had undergone X-ray of the abdomen and pelvis and contrast enema. All of them have undergone both SRB and FTRB, and their results were compared.

Results:

Out of 41 children, 26 were male and 15 were female. The children were aged from 5 days to 12 years. All of them presented with delayed passage of meconium, abdominal distension, and severe constipation. They all were on oral laxatives. The sensitivity and specificity of SRB are 80.95% and 90.00% when compared to FTRB which has 100% and 100%, respectively.

Conclusion:

FTRB is the gold standard test for diagnosing HD. SRB may be a good screening test in suspected HD cases. SRB is not as equal and effective as FTRB for diagnosing HD.
An Analysis of Safety and Efficacy of Day-care Surgery in Children in a Tertiary Care Hospital in India
Authors: Kumar Ravikesh , Choudhury Subhasis Roy , Yadav Pratap Singh , Kundal Raksha , Gupta Amit , Hayaran Nitin , Chadha Rajiv
Published: May 2021

Background:

Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice.

Aims and Objectives:

This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children.

Materials and Methods:

In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded.

Results:

Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent.

Conclusions:

DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.
Congenital Pouch Colon
Authors: Duci Miriam , Fascetti-Leon Francesco , Pergola Enrico La , Midrio Paola , Gamba Piergiorgio
Published: May 2021

Background:

Congenital pouch colon (CPC) is a rare variant of anorectal malformations (ARM) with its highest reported incidence in India. We aimed to describe five patients affected by CPC, in which the tissue from the terminal dilated colon has been successfully used and to discuss our results on the light of an extended revision of the literature.

Materials and Methods:

The clinical details of five cases treated for CPC in two Italian Centers were retrospectively reviewed assessing the fate of the terminal dilated colon.

Results:

In all cases, the tissue from dilated colon has been used. The double vascular system of the dilated pouch allowed increasing bladder capacity (case 4), reconstruction of the vagina (case 3, 5), and lengthening of the colon (case 1, 2, 5).In our series, 3/5 have a good bowel control with daily bowel management after ARM correction. In literature, there are not differences in terms of dependence from bowel management in patients with pouch resected and in patients with pouch saved (P = 0.16).

Conclusions:

We acknowledge that the analysis of the available literature is limited by the absence of studies with high level of evidence and the removal or the preservation of the abnormal colon tissue seems to follow the surgeon preferences.
Isolated Fetal Ascites
Authors: Sablok Aanchal , Sharma Akshatha , Gupta Rachna , Thakur Seema , Kaul Anita
Published: May 2021

Introduction:

Isolated fetal ascites is an uncommon finding, and it may be difficult to elucidate the underlying pathology. This is more so when there are limited resources to investigate the patient adequately. This study was undertaken to see the etiology of isolated fetal ascites and analyze the outcomes.

Materials and Methods:

Twenty-three cases of isolated fetal ascites were retrospectively analyzed from December 2007 to June 2018. All cases were investigated with detailed ultrasound with other investigations as required. Postnatal data included gestational age at birth, mode of delivery, weight, and postnatal outcome.

Results:

The mean age at diagnosis was 26 gestational weeks. Structural abnormalities without any underlying chromosomal or genetic cause were identified in 10/23 (43.4%) cases with the most common structural abnormality related to the gastrointestinal tract where ultrasound proved to the most useful tool. The overall good prognosis was seen in 13/23 (56.5%) cases.

Conclusion:

Appropriate perinatal care, timely referral and delivery at tertiary care setup, and timely surgical intervention are measures which can improve the outcome and survival in fetuses diagnosed with isolated fetal ascites.
Mesenchymal Hamartoma of the Chest Wall in an Infant – A Benign Entity Masquerading as Malignancy
Authors: Mahalingam Harshavardhan , Ramasundaram Madhu , Rajendiran Swaminathan , Jayaraman Dhaarani
Published: May 2021

Mesenchymal hamartoma of the chest wall is a rare tumor-like lesion encountered in neonates and infants. Although typically benign with no metastatic potential, it has alarming imaging and pathological features that mimic malignancy. We describe the imaging, surgical, and pathological features of this rare entity in a 1-month-old infant.