Is There Correlation Between Aluminum-Based Food Consumption and Plasma Level in Pregnant Women?

To explore the correlation of AL-based food consumption, known to have negative impact on health, and Al plasma levels with pregnancy status. A cross-sectional study was conducted on 75 participants, including 50 pregnant women. Al plasma levels were analyzed by ET-AAS. Exposure to food was positively correlated to Al mean plasma levels (reaching 2.12 ± 1.17 µg/L) by 32%, specifically for potatoes, fruits, soft drinks, and ready meals. Usage of Al cookware was associated to higher Al plasma levels while pregnancy status was protective. Establishment of national recommendation to maintain lower levels of Al in food is required.

The home handedness questionnaire: pilot data from preschoolers.

While handedness questionnaires are widely used in adults, there is no comparable measure designed specifically for children. The current study developed the Home Handedness Questionnaire (HHQ), a new measure for preschoolers administered by parents using common household items. The HHQ has two scales that distinguish action types typically combined on other measures: actions performed with only the right or left hand (i.e., unimanual, such as holding a toothbrush), and actions performed with one hand holding the object for the other hand's action (i.e., role-differentiated bimanual manipulation or RDBM, such as unscrewing a lid from a jar). The HHQ was able to detect right preference, left preference, and no preference for unimanual and RDBM actions in a proof of concept study in 3-year-olds (N = 64). The HHQ identified a majority of children as right-handed, but was also sensitive to variability in direction across skill types. Approximately one-quarter of children in the sample had mixed preferences for the two types of manual skills, suggesting that for a subgroup of children, hand use patterns may still be undergoing change. Suggestions for refining the HHQ are discussed. Overall, the HHQ is a promising multidimensional parent-led tool for assessing preschool handedness.

Normogram of Middle Cerebral Artery Doppler Indexes and Cerebroplacental Ratio at 12 to 14 Weeks in an Unselected Pregnancy Population.

OBJECTIVE: The aim of this study is to assess the feasibility of visualizing the middle cerebral artery (MCA), establishing the normogram for MCA pulsatility index (PI) and peak systolic velocity (PSV), and calculating cerebroplacental ratio (CPR) at 12 to 14 weeks. STUDY DESIGN: Prospective cross-sectional study on 186 gravidas presenting for nuchal translucency (NT) assessment. Maternal body mass index (BMI), fetal crown-rump length (CRL), biparietal diameter (BPD), and NT were obtained. Color Doppler was utilized to visualize the MCA and measure PI, PSV, and umbilical artery PI. Normograms for MCA PI and PSV, and for CPR, were constructed. Regression analysis was used for the reference range of MCA PI and CPR according to CRL and BPD. Chi-square and t-test were utilized. p-Value of < 0.05 was considered significant. RESULTS: MCA was successfully visualized in 176/186 (94.6%), PI and PSV measured on 148/186 (79.6%) and 145/186 (78.0%), respectively, and CPR calculated in 133/186 (71.5%). There was no significant effect of BMI, CRL, or BPD on successful assessment of MCA or CPR. Normograms for MCA PI and CPR revealed no significant relation with CRL or BPD. CONCLUSION: MCA and CPR assessment is feasible at 12 to 14 weeks. A reference range for MCA Doppler indexes and CPR at 12 to 14 weeks has been established. This may prove helpful in the early evaluation of fetuses identified as at-risk for adverse neonatal outcome.

Are There Head Volume Alterations at 11 to 14 Weeks in Fetuses with Congenital Heart Defects? A First Trimester Case Series.

Objective This study aims to assess head volume (HV) alterations at 11 to 14 weeks in fetuses with congenital heart defects (CHD). Methods A retrospective case-control study on 100 normal and 26 CHD fetuses was conducted. The fetuses had a first trimester scan with volume data sets stored from which HV was calculated. The mean HV and HV as a function of crown-rump length (CRL) in normal fetuses were compared with established normograms. Mean HV, HV as a function of CRL, and HV/CRL were compared between normal and CHD fetuses. Nonparametric Kruskal-Wallis H test was used with p < 0.05 considered significant. Results Overall, 83 normal and 19 CHD fetuses were included. The mean HV and HV as a function of CRL in the normal fetuses were comparable to what has been established (p = 0.451 and 0.801, respectively). The mean HV was statistically smaller in fetuses with CHD, particularly those with hypoplastic left heart (HLH): 10.7 mL in HLH versus 13.0 mL in normal fetuses (p = 0.043). The HV/CRL was statistically smaller in fetuses with CHD (p = 0.01). Conclusion Despite the small sample size, our case series suggests that alterations in HV may potentially be apparent as early as 11 to 14 weeks in CHD fetuses, particularly those with HLH. Larger prospective studies are needed to validate our findings.

Reference values for the right and left fetal choroid plexus at 11 to 13 weeks: an early sign of "developmental" laterality?

OBJECTIVES: The purpose of this study was to establish reference values for the length, area, and circumference of the right and left fetal choroid plexus at 11 to 13 weeks with respect to the fetal biparietal diameter and to compare the right to the left side. METHODS: We conducted a prospective study on 114 fetuses at 11 to 13 weeks undergoing first-trimester screening for aneuploidy and structural fetal abnormalities. After the establishment of the fetal situs, the plane of the "butterfly" was obtained on all fetuses, from which the length, area, and circumference of both the right and left choroid plexus were obtained and the right and left sides compared. Using a paired t test, analysis of variance, scatterplots, and linear and logarithmic fittings, reference ranges and charts for the length, area, and circumference of the choroid plexus were then formulated according to their relationship to the fetal biparietal diameter. P < .05 was considered statistically significant. RESULTS: Reference values for the length, area, and circumference of the fetal choroid plexus, with respect to the fetal biparietal diameter, were established. There was a statistically significant difference between the right and left sides for all parameters, with all measurements statistically greater on the left side (P < .0001). CONCLUSIONS: Reference values for the length, area, and circumference of the fetal choroid plexus at 11 to 13 weeks are presented. These may prove to be of clinical importance in the early screening for central nervous system abnormalities. In addition, the statistically significant difference between the right and left sides may be an early sign of "developmental" laterality.

Defining the spatial relationships between eight anatomic planes in the 11+6 to 13+6 weeks fetus: a pilot study.

OBJECTIVE: Our study aims at investigating the spatial relationships between eight anatomic planes in the 11+6 to 13+6 weeks fetus. METHODS: This is a retrospective pilot study where three-dimensional and four-dimensional stored data sets were manipulated to retrieve eight anatomic planes starting from the midsagittal plane of the fetus. Standardization of volumes was performed at the level of the transverse abdominal circumference plane. Parallel shift was utilized and the spatial relationships between eight anatomic planes were established. The median and the range were calculated for each of the planes, and they were evaluated as a function of the fetal crown-rump length. P < 0.05 was considered statistically significant. RESULTS: A total of 63 volume data sets were analyzed. The eight anatomic planes were found to adhere to normal distribution curves, and most of the planes were in a definable relationship to each other with statistically significant correlations. CONCLUSION: To our knowledge, this is the first study to describe the possible spatial relationships between eight two-dimensional anatomic planes in the 11+6 to 13+6 weeks fetus, utilizing a standardized approach. Defining these spatial relationships may serve as the first step for the potential future development of automation software for fetal anatomic assessment at 11+6 to 13+6 weeks.

Learning curve and factors influencing the feasibility of performing fetal echocardiography at the time of the first-trimester scan.

The purpose of this study was to assess the learning curve and factors influencing the feasibility of performing a complete fetal cardiac examination at the time of the first-trimester scan. The study included 103 fetuses undergoing first-trimester scans. The maternal body mass index, fetal crown-rump length, and 8 cardiac parameters were evaluated: 4-chamber view, tricuspid regurgitation, outflow tract crossover, bifurcating pulmonary artery, 3-vessel view, aortic arch, superior and inferior venae cavae on sagittal views, and Doppler images of the ductus venosus. All examinations were performed transabdominally by a single sonologist. The average times from the first to last cardiac images obtained were calculated. A complete examination was feasible in 55% of the cases: 15% of the first 52 and 94% of the last 51. Of the 8 cardiac parameters, 59.5% were seen in cases 1 to 21, 75.0% in cases 22 to 52, and 98.6% in the last 51 cases (P = .0001). The average times spent on the examinations increased from 4.37 to 9.3 minutes among the 3 groups (P = .032). There was no statistically significant influence for the crown-rump length (P = .899) or body mass index (P = .752). This study indicates that a fetal cardiac examination is feasible in the first trimester. Sonographer experience and the examination duration seem to be the most influential factors affecting the completeness of the examination.

[Vegetable foreign body of the infratemporal fossa: a case report]. / Corps étranger végétal de la fosse infratemporale.

INTRODUCTION: Limited amplitude of mouth opening due to a foreign body in the infratemporal fossa is a rare event. We report a trismus due to a foreign body of vegetable origin located in the infratemporal fossa. OBSERVATION: A 44-year-old female patient presented with a left endobuccal wound made by an oak branch. Limited amplitude of mouth opening was noted on clinical examination. A first CT scan did not reveal any foreign body. Despite an adequate treatment, the patient presented with acute cellulitis. A second CT scan revealed a parapharyngeal and masticatory compartment collection. One month after drainage, the patient spontaneously rejected the vegetable foreign bodies. An MRI better investigated the lesional diagnosis and the patient underwent surgery for the third time. DISCUSSION: Discovering foreign bodies in the infratemporal fossa is unusual. CT scan is a useful but limited tool if foreign bodies are small and/or of weak density. MRI is the reference examination.

[Dry cough, chest pain and difficult breathing in a patient with rheumatoid arthritis]. / Toux sèche, douleurs thoraciques et dyspnée chez un patient atteint d'une polyarthrite rhumatoïde.

Pulmonary involvement is the most frequent extra-articular manifestation of rheumatoid arthritis. The occurrence of a chronic hydro-pneumo-thorax associated with pulmonary nodules is rare. Cavitation of the most superficial nodules and their rupture into the pleural cavity are most likely involved in this complication. The presence of broncho-pleural fistulae may be responsible for the persistence of the phenomenon in our patient.

Cardiac troponin T: a useful early marker for cardiac and respiratory dysfunction in neonates.

BACKGROUND: Cardiac troponin T (cTnT) has been proposed as specific biochemical marker for myocardial infarction in adults. Cardiac function in neonates could be influenced by the severity of respiratory distress and its ventilatory management. OBJECTIVES: To establish a normal range of cTnT in healthy neonates, compare troponin concentrations among healthy neonates and those in respiratory distress (sick) and detect whether any correlation occurs between severity of respiratory distress and troponin concentrations. METHODS: Concentrations of cTnT were compared between sick and healthy infants, accounting for confounding variables in a prospective investigation manner. Age at sampling, need for ventilation, duration of respiratory support, and inotropic use in addition to neonatal and maternal characteristics were assessed. RESULTS: Samples were collected from 164 neonates (116 healthy and 48 sick). The medians [interquartile ranges] of cTnT in healthy and sick infants were 0.044 [0.027-0.073]mug/l and 0.121 [0.065-0.238] microg/l, respectively, with p < 0.0001. The 99th percentile for healthy neonates was 0.244 microg/l. Comparing both groups, there were significant differences concerning gestation, birth weight, Apgar at 5 min and admission to neonatal intensive care unit. Troponin concentrations in subgroups of sick infants including hypotensive, ventilated and dead infants were higher than other infants of the same subgroup. CTnT was positively correlated to the duration of respiratory support in ventilated neonates. CONCLUSION: CTnT may prove to be a useful early marker for cardiac and respiratory dysfunction in newborns.

Recurrent acute low back pain secondary to lumbar epidural calcification.

INTRODUCTION: Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. CASE REPORT: We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. DISCUSSION: We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space.

Effectiveness of local anaesthesia (clonidine and fentanyl) infiltration for post-submucosal resection pain relief: a randomized, double-blinded clinical trial.

BACKGROUND: Submucosal resection is accompanied by significant post-operative pain and discomfort. The aim of this randomized, double-blinded clinical trial was to study the efficacy of a local block anaesthetic, delivered after induction of general anaesthesia, in reducing post-operative pain. METHODS: Patients aged 16 years and over who were scheduled for elective submucosal resection were randomly assigned to receive either standardized general anaesthesia, general anaesthesia with local anaesthetic infiltration or general anaesthesia with placebo infiltration. Haemodynamic stability, intra-operative blood loss, post-operative pain (over a seven day follow-up period), analgesics consumption, hospital stay, and the patient's and surgeon's levels of satisfaction were assessed. RESULTS: We found significantly lower results for pack removal pain score, volume of intra-operative blood loss, number of patients suffering from headache, altered dental sensation or nasal pain, number of patients who consumed analgesics, and length of hospital stay, comparing the infiltration group with the general anaesthesia and placebo groups (p<0.05). CONCLUSION: This clinical trial showed that infiltration with the local anaesthetics fentanyl and clonidine substantially reduced post-operative pain and shortened patients' hospital stay.

Pre-incisional infiltration for pediatric tonsillectomy: a randomized double-blind clinical trial.

OBJECTIVE: Tonsillectomy is frequently associated with post-operative pain of considerable duration. The aim of the current study is to corroborate our previous observational data by conducting a prospective double-blind placebo-controlled randomized clinical trial to determine the potential effect of pre-incision infiltration of local anesthesia on post-operative pain after tonsillectomy. DESIGN: Randomized double-blind controlled clinical trial. SETTING: Tertiary care facility in Beirut, Lebanon. PATIENTS: Ninety patients who underwent tonsillectomy allocated evenly in three groups. INTERVENTIONS: Pre-incision infiltration of 1.5 local anesthetic mixture in each tonsil was performed in conjunction with general anesthesia (infiltration, n=30). Pre-incision infiltration of 1.5 ml of 0.9% of normal saline was applied with general anesthesia (placebo, n=30). GA received only general anesthesia. OUTCOME MEASURES: Post-operative pain at rest, eating soft diet, jaw opening at 0, 6, 12, and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, parent and surgeon satisfaction, ear pain and analgesics consumption were assessed. RESULTS: Hemodynamic stability was maintained during pre, per and post-operation. 93.1% of infiltration group left the hospital the same day compared to 60% in placebo groups and 41.4% in general anesthesia group (p=0.001). Surgeon's satisfaction was significantly higher in infiltration group compared to placebo and general anesthesia groups (p=0.001). Parent's satisfaction was significantly higher in infiltration group (89.65%) compared to general anesthesia group (13.8%) and placebo group (36.7%) (p=0.001). The average pain scores at rest, on jaw opening and when eating soft diet were significantly lower in infiltration group compared to placebo group and general anesthesia group (p<0.05). Analgesic consumption in placebo and general anesthesia groups were significantly higher compared to infiltration group (p<0.05). CONCLUSION: This modified pre-incision infiltration of anesthetic mixture combined with general anesthesia reduces significantly post-tonsillectomy pain in children and provides a more rapid return to normal activity compared to general anesthesia alone or in combination with a placebo infiltration.

Distance between the skin and the thoracic paravertebral space.

A fundamental requirement for the safe and effective performance of paravertebral blockade is reliable estimates of the depth from skin to paravertebral space at different thoracic levels. This distance was assessed using a nerve stimulator guided paravertebral blockade technique in 527 separate blocks in 186 patients scheduled for various surgical procedures on the trunk. The median skin-paravertebral depth was 55.0 mm. The skin-paravertebral distance at upper (T1-3) and lower (T9-12) thoracic levels were significantly greater than mid-thoracic levels (T4-8) (p < 0.05). Body mass index significantly influences this depth at upper and lower thoracic levels (p < 0.001) but not in the mid-thoracic region.

Modified infiltration technique in tonsillectomy: expanded case report of 25 children.

OBJECTIVE: To introduce a modified infiltration technique of anesthetic mixture in order to reduce post-tonsillectomy pain based on histo-anatomic observations and tonsil's innervation detection. DESIGN: Histo-anatomic, expanded case report. SETTING: Tertiary care facility in Beirut, Lebanon. PATIENTS: One hundred and seven patients who underwent tonsillectomy allocated in three groups. INTERVENTIONS: Histo-anatomic observations were studied in 62 patients (group I). Nerve-stimulator detection was performed in group II (20 children). An expanded case report of 25 children (group III) was conducted using a modified infiltration technique based on the findings of the histo-anatomic observations and nerve detection. OUTCOME MEASURES: Post-operative pain at 0, 6, 12h and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, patient satisfaction and analgesics consumption were assessed. RESULTS: The nerve-stimulator confirmed the histo-anatomic findings by strong contractions of the superior constrictor muscle, soft palate and uvula when the needle is mainly in the middle part of the peritonsillar area where the glossopharyngeal nerve branches predominate. No visual analogue scale median exceeded 1 for any child at any predetermined time interval, only three children (12%) required opoiods during the follow-up period. All children (100%) were discharged the same day, only 4% of parents were unsatisfied. Hemodynamic stability was maintained during pre- and post-operation. CONCLUSION: This modified technique with minimal volume of anesthetic mixture seems to reduce post-operative pain in tonsillectomy patients; a randomized double-blinded prospective study was designed based on the findings in this initial series of children.

General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial.

BACKGROUND AND OBJECTIVE: The efficiency of bilateral paravertebral blockade combined with general anaesthesia (active) vs. general anaesthesia alone (control) in reducing postoperative pain following laparoscopic cholecystectomy was evaluated using a prospective randomized study design. METHODS: Patients were randomly assigned to either group. Nerve-stimulator guided paravertebral blockade at the T5-6 level was performed with a local anaesthetic mixture (0.30 mL kg(-1)). Twenty millilitres of the mixture contained lidocaine 2% 6 mL; lidocaine 2% 6 mL with epinephrine 1/200 000; bupivacaine 0.5% 5 mL; fentanyl 1 mL (50 microg mL(-1)) and clonidine 2 mL (150 microg mL(-1)). Postoperative pain and consumption of opioids were assessed during the first 72 h. RESULTS: Two-times 30 patients were analysed. Patient characteristics data, and pre- and peroperative variables were similar in both groups. Mean pain scores visual analogue scale were significantly less with active compared with control (P < 0.05) at 6h (1.56 +/- 1.58 vs. 4.78 +/- 1.67), at 12 h (1.52 +/- 1.58 vs. 3.81 +/- 1.63), at 24 h (1.16 +/- 1.34 vs. 2.71 +/- 1.50), at 36h (0.68 +/- 1.02 vs. 2.29 +/- 1.41), at 48h (0.60 +/- 1.04 vs. 1.61 +/- 1.33) and at 72 h (0.40 +/- 0.86 vs. 1.19 +/- 1.16). The number of patients consuming supplemental analgesics was significantly less (P < 0.05) with active compared with control, at 6 h (6 vs. 29), at 12 h (2 vs. 26), at 24 h (1 vs. 23) and at 36 h (2 vs. 15). More patients were free from nausea (P < 0.05) with active compared with control at 6 h (23 vs. 9) and at 12 h (29 vs. 19). CONCLUSION: When used as a complement to general anaesthesia, bilateral nerve-stimulator guided paravertebral blockade with lidocaine, bupivacaine, fentanyl and clonidine may improve postoperative pain relief.

Varying anatomical injection points within the thoracic paravertebral space: effect on spread of solution and nerve blockade.

The factors responsible for the spreading pattern of a single paravertebral injection are still uncertain. In this study, 28 patients were randomly assigned to receive a paravertebral injection of radio-opaque dye (10 ml, with or without co-administration of 20 ml of local anaesthetics) either dorsal or ventral to the endothoracic fascia. The point of injection was determined by use of a nerve-stimulator and the radiographic distribution pattern was assessed blindly by a radiologist. Injections made in the more ventral part of the thoracic paravertebral space, supposedly anterior to the endothoracic fascia, resulted in a multisegmental longitudinal spreading pattern, whereas injections made dorsal to the endothoracic fascia resulted in a less predictable cloud-like spreading pattern, with only limited distribution over adjacent segments. The use of a nerve stimulator-guided technique appears to enhance the likelihood of achieving the more desirable longitudinal spreading pattern.

Nerve-stimulator guided paravertebral blockade vs. general anaesthesia for breast surgery: a prospective randomized trial.

BACKGROUND AND OBJECTIVE: Different anaesthetic techniques are used during breast surgery but are frequently associated with unsatisfactory postoperative analgesia. Paravertebral nerve blockade has recently been proposed as a favourable alternative for this type of surgical procedure, providing excellent pain relief and a reduced incidence of postoperative nausea and vomiting. The aim of the present study was to compare the use of a nerve-stimulator guided paravertebral nerve blockade technique to regular general anaesthesia for breast surgery. METHODS: Sixty patients were prospectively randomized to receive either paravertebral nerve blockade or general anaesthesia for breast surgery. The primary end-point of the study was to assess postoperative analgesia (visual analogue scale and supplemental opioid requirements); the incidence of postoperative nausea and vomiting and length of hospital stay were considered as secondary outcome measures. RESULTS: Visual analogue scores both at rest and at movement, as well as the need for supplemental opioid administration during the first 3 days postoperatively, were significantly lower in patients handled with para-vertebral nerve blockade compared to patients receiving general anaesthesia (P < 0.05). The number of patients free from nausea and vomiting after operation was significantly higher in the paravertebral nerve blockade group (93%) compared to the general anaesthesia group (67%) (P < 0.05). The use of paravertebral nerve blockade was also associated with a significantly shorter hospital stay (median 1 day) compared to general anaesthesia (2 days) (P < 0.01). Both the performance of the block and the intraoperative conditions was well accepted by the vast majority of patients treated by paravertebral nerve blockade (97%). CONCLUSION: The use of paravertebral nerve blockade was associated with improved postoperative pain relief, a reduced incidence of nausea and vomiting after operation and a shorter duration of hospital stay compared to general anaesthesia in patients undergoing breast surgery.