Successful pregnancy and delivery in a woman with a single ventricle and Eisenmenger syndrome

Patients with a single ventricle represent a rare abnormality found in 1% of patients with congenital heart disease, often discovered during childhood. Without pulmonary stenosis, the disease can progress to fixed pulmonary hypertension. Both pregnancy and delivery are risky events capable of increasing the right-to-left shunt. Pregnancy is contraindicated. We report the case of a 27-year-old woman with a single ventricle without pulmonary protection and fixed pulmonary hypertension at 60 mmHg, discovered during a pregnancy. The delivery was obtained by cesarean section with epidural anesthesia and the patient was perioperatively treated with nitric oxide. Though contraindicated, pregnancy and delivery were successfully achieved in this patient. Patients with single ventricle and Eisenmenger syndrome rarely reach adult life. Pregnancy with this condition is exceptional and fundamentally perturbs hemodynamic stability. In spite of the development of anesthesia and resuscitation and the description of some cases in literature, pregnancy with Eisenmenger syndrome is contraindicated.

Indoor air pollution and acute lower respiratory infections in the first two years of life

The relationship between outdoor air pollution and acute respiratory infections [ARI] was previously documented. There are recent indications for connection between indoor air pollution and ARI in infants and young children. The aim of this study was to identify the relationship of indoor air pollutants to acute lower respiratory infection [ALRI] in children [< 2 years]. The indoor air pollutants concentrations were measured in the homes of the sample. The sample consisted of 115 children [< 2 years] representing the control group [24], ALRI but no pneumonia [24], pneumonia [30], severe pneumonia or very severe disease [37]. Air sampling was performed to measure the concentration of total suspended particulates [TSP], SO[2] and CO. These pollutants were found in higher concentrations in cases' homes [52.46 +/- 19.68 micro g/m[3], 298.15 +/- 669.37 micro g/m[3], and 1.92 +/- 3.60 ppm] than in controls homes [31.92 +/- 8.76 micro g/m[3], not detected, and 0.33 +/- 1.63 ppm respectively]. Whereas SO[2] was detected only in houses using kerosene, TSP and CO were detected with the different types of cooking fuels. Their mean concentrations were highest for biomass [88.86 +/- 13.30 micro g/m[3] and 9.29 +/- 2.50 ppm] and lowest for gas [40.78 +/- 15.25 micro g/m[3] and 0.76 +/- 2.19 ppm]. Measures to improve indoor air quality are highly required

Some risk factors of lower respiratory tract infections in the first two years of life

To define the risk factors related to the occurrence and severity of acute lower respiratory tract infections [ALRI] in the first two years of life, a case-control study was carried out in the three main pediatric hospitals in Alexandria. The study sample constituted of 331 case-control pairs of <2 years children matched for age and sex. Through interviewing their mothers, data concerning their social background, knowledge, attitude and practices [KAP] of mothers regarding acute respiratory infections, and indoor air quality were collected. The weight and length of children were measured to assess their nutritional status. Using the univariate analysis, all factors studied were found to be significantly related to occurrence of ALRI except breast feeding, attendance in day care centers and regular use of insecticides. Using the multiple logistic regression analysis appropriate weight-for-age, better indoor air quality score, higher social status, and better knowledge, attitudes and practices of mothers regarding ARI were inversely related to the occurrence of ALRI [OR = 0.076, 0.307, 0.811, 0.571, 0.324 and 0.356, respectively]. The social status, immunization, indoor air quality, attitude and practices of mothers regarding ARI, weight-for-age as well as length-for-age were significantly related to the severity of ALRI. Health education programs were recommended to improve mothers' practices regarding ARI and the indoor air quality