Iatrogenic Esophageal Perforation in Premature Infants: A Multicenter Retrospective Study from Poland.

Greater awareness of possible iatrogenic esophageal perforation (EP) is needed. Though rare, EP is a legitimate health risk as it may lead to long-term morbidities. This study presents and discusses iatrogenic EP in a subset of preterm infants. Using radiographic images, we study and describe the consequences of the orogastric/nasogastric tube position (in radiographic images). We analyze the possible influence of histological chorioamnionitis on the development of esophageal perforation. This retrospective study examines the hospital records of 1149 preterm infants, 2009-2016, with very low birth weight (VLBW) and iatrogenic EP, comparing mortalities and morbidities between the two groups of preterm infants who had birth weights (BWs) of less than 750 g and were less than 27 weeks gestation age at birth: one group with iatrogenic esophageal perforation (EP group) and one group without perforation (non-EP group-the control group). Histopathological chorioamnionitis of the placenta showed no statistically significant differences between the groups. The only statistically significant difference was in the air leaks (p = 0.01). Three types of nasogastric tube (NGT) X-ray location were identified, depending on the place of the perforation: (1) high position below the carina mimicking esophageal atresia; (2) low, intra-abdominal; (3) NGT right pleura-directed. We also highlight the particular symptoms that may be indicative of EP due to a displacement of the nasogastric tube.

Adverse outcome of T3-predominant maternal Grave's disease during pregnancy in the mother and the offspring.

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Baseline Proteinuria and Serum Creatinine Concentration as Clinical Predictors of Complete Renal Response in Patients with Lupus Nephritis: A Single-Center Experience.

The aim of the study was to identify robust predictors of complete renal response (CRR), within 36 months, in a single-center cohort of lupus nephritis (LN) patients. Patients with biopsy-confirmed LN who underwent kidney biopsy between 1 January 2010 and 31 December 2020 were included and followed up for at least 6 months. CRR was defined as a reduction of urinary protein-to-creatinine ratio (UPCR) below 0.50 g/g. We evaluated baseline demographic, laboratory, and biopsy characteristics as potential predictors of CRR, and selected the variables further evaluated with Kaplan−Meier curves and log-rank tests. The traits with a p-value < 0.1 were later tested with both uni- and multivariable Cox proportional hazard models. Our sample consisted of 57 patients (84% females, median age 32 years), out of which 63.2% reached CRR within 36 months. The initial UPCR and estimated glomerular filtration rate (eGFR) were the only variables in multivariable Cox regression model, which were selected through backward elimination, with a significance threshold <0.05 (HR = 0.77, p = 0.01 and HR = 1.02, p = 0.001). Our results confirmed the role of initial UPCR and serum creatinine concentration (sCr) as predictors of CRR in LN.

Artificial neural network - an effective tool for predicting the lupus nephritis outcome.

BACKGROUND: Lupus nephropathy (LN) occurs in approximately 50% of patients with systemic lupus erythematosus (SLE), and 20% of them will eventually progress into end-stage renal disease (ESRD). A clinical tool predicting remission of proteinuria might be of utmost importance. In our work, we focused on predicting the chance of complete remission achievement in LN patients, using artificial intelligence models, especially an artificial neural network, called the multi-layer perceptron. METHODS: It was a single centre retrospective study, including 58 individuals, with diagnosed systemic lupus erythematous and biopsy proven lupus nephritis. Patients were assigned into the study cohort, between 1st January 2010 and 31st December 2020, and eventually randomly allocated either to the training set (N = 46) or testing set (N = 12). The end point was remission achievement. We have selected an array of variables, subsequently reduced to the optimal minimum set, providing the best performance. RESULTS: We have obtained satisfactory results creating predictive models allowing to assess, with accuracy of 91.67%, a chance of achieving a complete remission, with a high discriminant ability (AUROC 0.9375). CONCLUSION: Our solution allows an accurate assessment of complete remission achievement and monitoring of patients from the group with a lower probability of complete remission. The obtained models are scalable and can be improved by introducing new patient records.

Correlation Between Thyroid Hormone Concentrations and Ultrasound Thyroid Volume in Preterm Infants Born Before 33 Weeks of Gestation.

Objective: Thyroid disorders are commonly concomitant with premature birth; however, indications to start therapy remain unclear due to a lack of gestational age (GA)-specific reference ranges. We aimed to evaluate the age-specific thyroid-stimulating hormone (TSH), free thyroxine (FT4) levels and the correlation between TSH and FT4 serum levels and ultrasound thyroid volume in preterm infants. Materials and Methods: This was an observational, prospective, single-center study of 98 preterm infants born before 33 weeks GA. The infants were divided into the 24-28 weeks and 29-32 weeks GA groups. TSH and FT4 serum levels were measured at two time points: at postnatal age (PNA) 2 weeks and at postmenstrual age (PMA) 32 weeks; the results were compared between groups at two consecutive time points. Results: There was a statistically significant between-group difference in FT4 concentration. There was a positive correlation between FT4 and GA at both screening times. FT4 in the 24-28 weeks GA group was significantly lower than in the 29-32 weeks GA group. The mean (standard deviation [SD]) FT4 at PNA 2 weeks was 11.72 ± 2.16 pmol/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p<0.001). The mean (SD) FT4 at PMA 32 weeks was 11.96 ± 1.98 pmo/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p=0.001). Our results reflect a slow and gradual upward trend of FT4 in the 24-28 weeks GA. It is of interest that the correlation between thyroid volume and FT4 was statistically significant (rho=0.25, p=0.019) for all studied preterm infants. The correlation between thyroid volume and weight was statistically significant for the entire study group (rho=0.37, p<0.001). We did not find statistically significant differences in TSH and FT4 values between consecutive time points at 24-28 weeks GA. The thyroid volume was not significantly different between both groups. The total thyroid volume was 0.26 vs. 0.27 ml for the 24-28 and 29-32 weeks GA groups, respectively. Conclusion: The results of this study indicate that preterm infants require lower FT4 values depending on GA. Moreover, ultrasound thyroid imaging may facilitate the evaluation of questionable thyroid disorders.

Timing of Graves' Hyperthyroidism Management in Pregnant Women: Impact on the Infant Thyroid Volume.

The thyroid of the fetus of a mother with Graves' disease (GD) is affected by the transplacental passage of both antithyroid drugs (ATDs) and thyroid-stimulating hormone receptor antibodies (TRAb). Thyroid hormone imbalances are harmful for the developing brain. This study aimed to evaluate the impact of the duration of antithyroid drug treatment in hyperthyroid pregnant women with GD on infants' thyroid volume. Twenty-nine neonates born to mothers with GD were divided into two groups depending on the duration of ATDs treatment. The ultrasound thyroid volumes of the infants were measured within the first week of life. Thyroid-stimulating hormone, thyroxine, and TRAb values were recorded. There was no difference between groups in the thyroid hormones' values. The median thyroid volume for the entire group of neonates with mothers with GD, for the groups of neonates of mothers with long- and short-treated GD, and for the control group were 1.539, 1.816, 1.347 and 1.014 mL, respectively. There were statistically significant differences in the thyroid volume between the GD group and the control group, as well as between the groups of neonates of mothers with long- and short-treated GD (p < 0.05). Studies have shown that the longer the duration of ATDs administration to mothers, the greater the thyroid volume of the neonate.

Comparison of the offspring ultrasound thyroid volume in hypothyroid mothers treated with different levothyroxine doses: A cohort study.

PURPOSE: We aimed to determine the volume of the thyroid gland in full-term neonates born to hypothyroid mothers as compared with full-term infants born to healthy mothers and to investigate the association between levothyroxine doses and the thyroid volume of neonates. MATERIALS AND METHODS: This is single center prospective observational study of 245 full-term neonates (96 from hypothyroid and 149 from healthy mothers). Ultrasound examination in both longitudinal and transverse projections was used to calculate the thyroid volume applying the ellipsoid formula. RESULTS: Median (interquartile range) thyroid volume of newborns from hypothyroid mothers was significantly smaller compared to the control group with regard to the total thyroid volume and the left lobe (p < 0.05). We found no statistically significant difference for the right lobe (p > 0.05) and inverse correlation between the thyroid volume and levothyroxine doses taken by mothers. CONCLUSION: Results of the present study indicate that maternal thyroid hormone levels may interfere with the fetal hypothalamic-pituitary axis.

Sequential sonographic features in neonatal renal vein thrombosis.

OBJECTIVES: Renal vein thrombosis in newborns is a rare but serious and acute disease. Clinical representations of RVT can vary from discrete symptoms to life-threatening conditions. Therefore imaging, and in particular sonography, plays an important role in the diagnosis of RVT in neonates. Gray-scale, color and spectral/power Doppler ultrasound are all used in the diagnosis of RVT. MATERIAL AND METHODS: We present retrospective sequential ultrasonic imaging of three patients (two term and one preterm infant) with findings characteristic of RVT. RESULTS: Initial ultrasound diagnostic features include: renal enlargement, echogenic medullary streaks, lack of the flow pattern characteristic of arcuate vessels and subsequently loss of corticomedullary differentiation, reduced echogenicity around pyramids and echogenic band at the extreme apex of the pyramid. Higher resistance index or less pulsatile venous flow on the affected kidney are helpful Doppler signs. CONCLUSIONS: Knowledge and identification of specific features of each phase of the evolution of RTV seems essential to prompt diagnosis. We would like to highlight the evolution of specific sonographic features in each subsequent phase of RVT.

Sonographic Reference Ranges for the Thyroid Gland in Euthyroid Term Newborns.

OBJECTIVE: This study aims to establish the reference ranges for normal thyroid gland (length, width, depth, and volume) in healthy term Polish neonates within the first week of life to aid in the comparative evaluation of infants with suspected thyroid disease. STUDY DESIGN: A total of 148 term neonates from mothers with normal thyroid function were examined during their first week of life. Ultrasound examination was performed in both longitudinal and transverse projections to create reference value percentile charts for thyroid volume in healthy term neonates. RESULTS: Median (range) width, depth, and length were 0.714 (range, 0.470-0.959), 0.677 (range, 0.527-0.960), 2.07 (range, 1.540-2.870) cm for the right lobe of the thyroid: and 0.720 (range, 0.535-1.010), 0.678 (range, 0.521-0.952), 2.015 (range, 1.620-2.730) cm for the left. Volumes for right lobe, left lobe, and both lobes combined were 0.502 (range, 0.228-0.931), 0.511 (range, 0.294-0.959), and 1.014 (range, 0.526-1.849) mL. CONCLUSION: Diagnostic ultrasound examination of the thyroid in the neonate is a simple and useful method for assessment of thyroid gland disease and neonatal health. This study provides robust normative data for Polish newborns. Furthermore, we have found different values compared with other countries, particularly Scotland, which underlines the importance of establishing population-based data.

[Ebers Papyrus. The book of medical knowledge of the 16th century B.C. Egyptians]. / Papirus Ebersa. Ksiega wiedzy medycznej egipcjan z XVI w P.N.E.

In 2nd century B.C. Clemens Alexanrinus was sure, that the Egyptians collected all their knowledge in 42 secret books. of which last six contained medical knowledge. Despite this and records of other ancient authors, for long time the opinion about the history of medicine was not changed. In traditional view the role of Hippocrates and the Greeks was emphasized. In 19th century egyptologist began finding Egyptian papyri, whose contents concerned medical matters. The first medical papyrus was published by Georg Ebers in 1875. The Ebers Papyrus is a scroll 20,23 meters in length and contains 108 columns of text. I is dated at the reign of Amenophis I (1536 B.C.). This papyrus was published and translated by different researches (the most valuable is German edition Grundriss de Medizin de alten ägypter, and based on this Paul Ghalioungui edition). In the opinion of Grundriss, chaotic arrangement of medical advices in papyrus suggest different originals from which they drew. The text of The Ebers Papyrus is ordered in series of prescriptions, which are grouped according to different diseases, illnesses and injuries. ALmost all of those groups have introduction by the formula: "Here begins.." used on 36 occasions. They are, however, often varied and disorganised. The owner of this papyrus was probably a physician - the text mentions about "physician secrets". Herodotus writes, that Egyptian physicians were specialized, which seems to be confirmed by The Ebers Papyrus.

[Effectiveness of passive immunisation against respiratory syncytium virus in a group of premature infants with birth weight below 1000 grams]. / Ocena skutecznosci stosowania uodpornienia biernego przeciwko wirusom syncytium nablonka oddechowego (RSV) preparatem Synagis w grupie wczesniakow z masa urodzeniowa ciala ponizej 1000 gramow.

Respiratory syncytial virus (RSV) is a major cause of respiratory tract infection during the child's first year of life. Those who survive neonatal intensive care are commonly rehospitalized. In the absence of vaccine, passive immunoprophylaxis is the preferred approach. Safety and efficacy of Palivizumab (Synagis) was proven in the Impact-RSV Trial, conducted in the USA, Canada and UK. The aim of the study was to determine efficacy of humanized monoclonal RSV antibody in prematures infants born 25-32 week gestation with weight birth below 1000 g with and without broncho-pulmonary dysplasia. We compared the hospitalization rates and morbidity between two groups of children who received palivizumab and without any protection. We confirm the efficacy and safety of Synagis. The outcome of this study supports the use of palivizumab prophylaxis in high-risk children.