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BACKGROUND: The value of ST analysis of the fetal electrocardiogram during labor to lower asphyxia and cesarean section rates is uncertain. Physiological variation of the electrical heart axis between fetuses may explain false alarms in conventional ST analysis (absolute ST analysis). ST events (alarms) based on relative T/QRS rises (relative ST analysis) correct for this variation and may improve diagnostic accuracy of ST analysis.AIMS: To compare the diagnostic accuracy of absolute and relative ST analysis with regard to fetal acidemia.STUDY DESIGN: Retrospective case-control study.SUBJECTS: 20 healthy women with an uncomplicated pregnancy monitored with ST analysis during labor: 10 cases (umbilical cord artery pH < 7.05) and 10 controls (pH > 7.20).OUTCOME MEASURES: Sensitivity, specificity, positive and negative likelihood ratio.RESULTS: In 16 of the 20 patients a total of 54 absolute ST events were reported. Two reviewers classified the cardiotocograms; in cases 29% of the absolute ST events were significant, in the controls it was 19%. Relative ST analysis versus absolute ST analysis showed a sensitivity of 90% (55-100%) vs. 70% (35-93%), a specificity of 100% (69-100%) vs. 70% (35-93%), a positive likelihood ratio of infinity vs. 2.3 (0.8-6.5), a negative likelihood ratio of 0.1 (0.0-0.6) vs. 0.4 (0.2-1.2), and diagnostic odds ratio of infinity vs. 5.4 (0.8-36.9). McNemar showed no statistical significant difference between the sensitivity and specificity of the methods.CONCLUSIONS: We observed higher positive and lower negative likelihood ratios for relative ST analysis in comparison to absolute ST analysis. In this small study we found no statistical difference. Relative ST analysis should be studied in a larger study.

Subcutaneous fat necrosis (SCFN) is inflammation and necrosis of adipose tissue associated with hypoxia and hypothermia. It leads to various metabolic abnormalities, of which the most dreaded is hypercalcaemia. We report a case of a 7-week-old boy with history of birth asphyxia (hypoxic ischaemic encephalopathy stage 3) who presented to us with features suggestive of hypercalcaemia with bilateral nephrocalcinosis. On examination, there were multiple subcutaneous nodules on both arms. Evaluation revealed suppressed parathyroid activity along with low levels of 25(OH)vitamin D3 and elevated 1,25-dihydroxyvitamin D3. Skin biopsy confirmed the diagnosis of SCFN. He was managed with intravenous fluids, single dose of intravenous furosemide and oral prednisolone. Hypercalcaemia responded within 14 days of admission, prednisolone was tapered and stopped in a month. SCFN, in our case, can be attributed to the underlying perinatal asphyxia along with use of therapeutic hypothermia. Through this case, we wish to sensitise practicing neonatologists for the need of screening and early identification of these abnormalities, which if missed can be fatal.

Background Respiratory distress (RD) is a common problem in the neonatal period and one of the most common reasons for neonates to be admitted to the neonatal intensive care unit (NICU) which frequently leads to neonatal mortality. However, there are few studies on neonatal respiratory distress and its associated factors in Ethiopia. This study was aimed to determine the prevalence and associated factors of respiratory distress in the neonatal intensive care unit at Mizan Tepi University teaching hospital. Methods An institutional based retrospective cross sectional study was conducted among preterm infants admitted in a neonatal intensive care unit (NICU) of Mizan Tepi University teaching hospital from May 9/2016 to December 30/2019. Simple random sampling technique was used to recruit a predetermined sample size by using registration numbers of the clients enrolled through computer generated random numbers. Binary Logistic regression was used to analyze the association between neonatal respiratory distress and explanatory variables. Explanatory variables that had a P-value of less than 0.25 and fulfilled the assumption of logistic regression from bi-variable logistic regression were considered for the multivariable logistic regression model. The strength of association was evaluated using an odds ratio at 95% confidence interval and a P-value Result The proportion of respiratory distress in the current study was 34.0% at 95% CI 29.4%–38.6%. Respiratory distress was significantly associated with being a multiple (twin) AOR = 1.8(1.05–3.09), non-cephalic presentation at delivery AOR = 4.9(1.96–12.2), presence of asphyxia AOR = 1.85(1.01–3.69), an APGAR of Conclusion The prevalence of neonatal respiratory distress in the current study was high. Nearly one out of three neonates admitted to Mizan Tepi University teaching hospital NICU's had respiratory distress. Respiratory distress was significantly associated with a low 5-min APGAR score, a gestational age between 28 and 31, a multiple (twin) pregnancy, non-cephalic presentation, and neonatal asphyxia. Therefore, health professionals working in the delivery room and/or the neonatal intensive care unit should be mindful of these associated factors for early detection and appropriate management of RD to ensure better outcomes in all infants presenting with respiratory distress.

Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault, which refers to strangulation or choking that does not result in death, is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE). A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants ( N = 882) ranged in age from 18 to 81 ( M = 28.85), with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from a logistic regression analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault. Results from chi-square analysis showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.

Kasih Ibu Hospital from October 2019 to January 2021 has become the referral maternal COVID-19 hospital in Surakarta, Central Java. Until now, research on pregnant women with COVID-19 in Indonesia is still very limited, it is still unknown whether there are possibility of vertical transmission from mother to baby, while pregnant women are among the vulnerable population. The purpose of this study is to provide an overview of the findings of positive infant outcomes for COVID-19 in pregnant women with confirmed COVID-19 at Kasih Ibu Hospital, Surakarta. Data collection was carried out by tracing medical records which were then presented in the form of distributions based on gestational age, infant birth weight, infant APGAR score, and infant COVID-19 status. Out of 62 pregnant women confirmed positive for COVID-19, 20 babies (32.3%) had PCR swab tests positive for COVID-19. All babies were born in good shape (APGAR score 8-10) and 4 babies were found with low birth weight, one of whom also had hypospadias. There were no reports of neonatal asphyxia and infant mortality.

Background. The prevalence of giardiasis among children is 355 cases per 100,000, with 80 % of cases of infestation occurring in children under the age of 14 years. The urgency of the high prevalence of protozoal pathology in children is determined by the fact that its manifestations are often masked under various pathological conditions. The purpose was to study the incidence, predictors and criteria for the diagnosis of giardiasis in children. Materials and methods. Research design is a controlled randomized trial. The study included children suffering from giardiasis (n = 55), aged 3 to 17 years. The comparison group consisted of 30 apparently healthy children. A survey of patients and collection of material performed at the outpatient and gastroenterology departments of the MHI “Chernivtsi Regional Clinical Hospital” during 2014–2016. Laboratory and instrumental investigations were conducted in Ukrainian-German laboratory “Bukintermed” and children’s gastroenterology center “Digest”. Indirect (serological one, macroscopy of the duodenal mucosa in endoscopic examination, indirect signs of giardiasis in duodenal biopsy samples) and direct methods were used (microscopy of the feces, duodenal contents, detection of vegetative forms of lamblia in duodenal biopsy samples during histological examination). A parent survey was conducted. Results. A positive result was obtained in 29 out of 565 subjects surveyed for lamblia (5.1 %). More often, additional examination was required for the presence of giardiasis in children suffering from chronic diseases of the upper gastrointestinal and hepatobiliary system, allergic reactions, intestinal dysbiosis and persistent eosinophilia. Children affected with giardiasis were more likely to have a concomitant illness than the children of the comparison group (p < 0.05). In 41.4 % of cases, children lived in conditions that were not satisfactory, did not always follow the rules of sanitary hygiene. We have established antenatal (health during pregnancy, the course of pregnancy, the presence of occupational hazards), intranatal (premature birth, stimulation of labor and cesarean section, birth trauma and asphyxia in children) and postnatal adverse factors (duration of breastfeeding, concomitant pathology). All histological features can be used as possible criteria for giardiasis in children, but with the highest probability, the following sign can be used — the presence of villous epithelium desquamation areas with simultaneous dominance of eosinophils and mast cells in the infiltrate. Conclusions. The incidence of giardiasis in children and adolescents is 5.1 %. Anamnestic factors (social, hygienic, medical and biological ones) established by us can be considered as predictors for the development of giardiasis in children. In the clinical picture of giardiasis, the defeat of the digestive tract dominates — in 96.3 % of children. To improve the accuracy of giardiasis diagnosis in children, it is necessary to use a set of direct and indirect methods of the diagnosis.

Метою проведеного дослідження було вивчення перебігу та результатів вагітності у пацієнток з високою легеневою гіпертензією. Наведені власні спостереження 14 вагітних жінок з високою легеневою гіпертензією, а також проведено аналіз експертних і літературних даних. Проаналізовано ефективність різних способів лікування і розродження цих жінок. З 14 пологів, що відбулися, шість були передчасними (42,9 %). У пацієнток, які спостерігалися нами, кесарів розтин було зроблено в 64,3 % випадків, пологи через природні родові шляхи відбулися в 35,7 % випадків. У стані асфіксії тяжкого ступеня народилося 21,4 % дітей, помірного — 35,7 %. Частота гіпотрофії плода при високій легеневій артеріальній гіпертензії склала 57,1 %. Не було жодного випадку материнської та перинатальної смертності.

Birth asphyxia is a major newborn mortality problem in low-resource countries. International guideline provides treatment recommendations; however, the importance and effect of the different treatments are not fully explored. The available data is collected in Tanzania, during newborn resuscitation, for analysis of the resuscitation activities and the response of the newborn. An important step in the analysis is to create activity timelines of the episodes, where activities include ventilation, suction, stimulation etc. Methods: The available recordings are noisy real-world videos with large variations. We propose a two-step process in order to detect activities possibly overlapping in time. The first step is to detect and track the relevant objects, like bag-mask resuscitator, heart rate sensors etc., and the second step is to use this information to recognize the resuscitation activities. The topic of this paper is the first step, and the object detection and tracking are based on convolutional neural networks followed by post processing. Results: The performance of the object detection during activities were 96.97 % (ventilations), 100 % (attaching/removing heart rate sensor) and 75 % (suction) on a test set of 20 videos. The system also estimate the number of health care providers present with a performance of 71.16 %. Conclusion: The proposed object detection and tracking system provides promising results in noisy newborn resuscitation videos. Significance: This is the first step in a thorough analysis of newborn resuscitation episodes, which could provide important insight about the importance and effect of different newborn resuscitation activities, 8 pages

AIM Birth asphyxia can lead to organ dysfunction, varying from isolated biological acidosis to hypoxic-ischemic encephalopathy (HIE). Pathophysiology of moderate or severe HIE is now well known and guidelines exist regarding the care required in this situation. However, for newborns without moderate or severe HIE, no consensus is available. Our objective was to describe the immediate neonatal consequences and need for care of asphyxiated newborns without moderate or severe HIE. METHODS Multicentre retrospective study from January 2015 to December 2017 in two academic centres, including neonates ≥37 gestational weeks with pathological foetal acidemia (umbilical arterial pH

Aims: To compare commonly mentioned risk factors between mild germinal matrix hemorrhage-Intraventricular hemorrhage (GMH-IVH) (grade I & II) and severe GMH-IVH (grade III & IV) and to study the long-term neurodevelopmental outcomes in relation to severe GMH-IVH. Study Design: Retrospective cohort study. Place and Duration of Study: Neonatal intensive care unit, King Fahad University Hospital, between 2000 and 2020. Methodology: We included 54 premature infants at ≤36 weeks of gestation and with birth weight

BackgroundIntrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region.MethodsA pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011–2013) and at second-phase follow-up (2017–2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression.ResultsManagement of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3–4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4–12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%).ConclusionSMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.

The prevalence of intracardiac thrombus (ICT) is gradually increasing, though it is rare among children. Data related to the occurrence of ICT among children are limited, and treatment recommendations have been made utilizing adult guidelines. The primary objective of this study is to determine associated factors, management, and outcomes of intracardiac thrombosis in children. Between January 2013 and January 2020, patients diagnosed with ICT at the Pediatric Hematology-Oncology and Pediatric Cardiology departments in our hospital were included in the study. Demographic characteristics, clinical and laboratory findings, treatment protocols, and outcomes were analyzed retrospectively. The median age at diagnosis was 10.5 months (2 days to 14.5 years), and the median follow-up period was 6.5 months (1 month to 3.1 years). The most common primary diagnoses of the patients, in order of frequency, were heart disease (n: 8), metabolic disease (n: 3), prematurity and RDS (n: 3), burns (n: 2), pneumonia (n: 2), and asphyxia (n: 2). CVC was present in 19/23 of the patients. The reasons for CVC insertion were the need for plasmapheresis in one patient with a diagnosis of HUS and the need for well tolerated vascular access because of long-term hospitalization in others. LMWH was administered to all patients as first-line therapy. Complete response was achieved in 19 (79%) of 24 patients and 4 patients (16.6%) were unresponsive to medical treatment. It was found out that the thrombus location, type, sepsis, and hemoculture positivity, as well as the presence of CVC, had no impact on treatment response (chi-square P = 0.16, 0.12, 0.3, 0.49, 0.56). Moreover, no correlation was determined between thrombus size and treatment response (Mann Whitney U test P = 0.47). The mortality rate was determined to be 12.5% (3/24). Spontaneous occurrence of ICT is rare in childhood, without any underlying primary disease or associated factor. The presence of CVC, sepsis, and heart disease are factors associated with ICT. The success rate is increased with medical treatment. There was no significant difference in treatment response between the newborn and 1 month to 18-year-old patient group. It has been demonstrated that thrombus size, type, localization; sepsis, and hemoculture positivity had no impact on the treatment response.

Aim: To study the clinical effect and safety of iron supplementation in the treatment of mild thalassemia complicated by iron deficiency in late pregnancy. Methods: 376 patients with mild thalassemia complicated by iron deficiency in late pregnancy treated in our hospital from July 2019 to June 2021 were selected and recruited in the research group, and 200 normal pregnant women treated in the same period were selected and recruited in the control group. Hemoglobin (Hb), reticulocyte blood, red blood protein (RET he) level, ferritin (SF) level, soluble transferrin receptor (sTfR) level, adverse maternal and infant outcomes, etc. were analyzed. Results: There was no significant difference in the levels of SF, Hb, RET he and sTfR between the two groups before treatment. After treatment, the levels of SF, Hb, RET he and sTfR in the research group were significantly improved, which was statistically significant compared with the control group. The frequencies of intrapartum hemorrhage, premature delivery, stillbirth, hemorrhagic shock, and neonatal asphyxia in the research group were 289±47.88, 36 (9.57%), 0 (0.00%), 25 (6.65%), and 6 (1.26%), respectively. The frequencies of intrapartum hemorrhage, premature delivery, stillbirth, hemorrhagic shock, and neonatal asphyxia in the control group were 284 ± 46.99, 7 (3.50%), 0 (0.00%), 6 (3.00%), and 0 (0.00%), respectively. There were significant differences in preterm delivery and hemorrhagic shock, and there was no significant difference in other delivery outcomes. Conclusions: Under the premise of strictly controlling the iron reserve in pregnant women, continuous medication until the end of delivery may be conducive to the control of maternal thalassemia complicated by iron deficiency and the improvement of pregnancy outcome.

Background The establishment of a risk-appropriate care approach for pregnant women and newborn infants under the COVID-19 pneumonia is vital to prevent the main pregnancy complications. Objectives and design This study reviewed the vertical transmission (VT) potential of COVID-19 pneumonia in pregnant women. Key-related symptoms and adverse clinical outcomes for mothers and infants before and after childbirth were summarized. Some practical therapies and preventive health solutions were also proposed. Results There was a high susceptibility in pregnant women to COVID-19 infection, especially in the third trimester of pregnancy. The most common symptoms in 22-40-year-old patients infected with COVID-19 were fever (87.6%), cough (52.3%), dyspnea (27.6%), fatigue (22.4%), sore throat (13.5%), malaise (9.4%), and diarrhea (3.4%), respectively. The viral infection led to an increase in preterm labor and cesarean delivery without any intrauterine infection and severe neonatal asphyxia. No infection in the newborn infants was reported despite a high risk of the VT phenomenon. The most important therapies were the reception of antiviral and antibiotic drugs, oxygenation therapy, psychological interventions, and food supplements with health-promoting effects. The best proposed medical strategies to control the COVID-19 infection were bi-monthly screening and following-up the mothers' and fetuses' health, not using the potent broad-spectrum antibiotics and corticosteroids, providing the delivery room with negative pressure for emergency cesarean section, and the immediate isolation of newborns after childbirth without direct breastfeeding. Conclusion Babies with respiratory problems may be born to some mothers with COVID-19, who have weak immune systems. Thus, the virus transmission cycle should be disrupted to prevent adverse maternal and fetal outcomes by integrating individual health guidelines, efficient medical care therapies, and hospital preventive practices.

BackgroundThe feasibility and benefits of continuous sustained inflations (SIs) during chest compressions (CCs) during delayed cord clamping (physiological-based cord clamping; PBCC) are not known. We aimed to determine whether continuous SIs during CCs would reduce the time to return of spontaneous circulation (ROSC) and improve post-asphyxial blood pressures and flows in asystolic newborn lambs.MethodsFetal sheep were surgically instrumented immediately prior to delivery at ~139 days’ gestation and asphyxia induced until lambs reached asystole. Lambs were randomised to either immediate cord clamping (ICC) or PBCC. Lambs then received a single SI (SIsing; 30 s at 30 cmH2O) followed by intermittent positive pressure ventilation, or continuous SIs (SIcont: 30 s duration with 1 s break). We thus examined 4 groups: ICC +SIsing, ICC +SIcont, PBCC +SIsing, and PBCC +SIcont. Chest compressions and epinephrine administration followed international guidelines. PBCC lambs underwent cord clamping 10 min after ROSC. Physiological and oxygenation variables were measured throughout.ResultsThe time taken to achieve ROSC was not different between groups (mean (SD) 4.3±2.9 min). Mean and diastolic blood pressure was higher during chest compressions in PBCC lambs compared with ICC lambs, but no effect of SIs was observed. SIcontsignificantly reduced pulmonary blood flow, diastolic blood pressure and oxygenation after ROSC compared with SIsing.ConclusionWe found no significant benefit of SIcontover SIsingduring CPR on the time to ROSC or on post-ROSC haemodynamics, but did demonstrate the feasibility of continuous SIs during advanced CPR on an intact umbilical cord. Longer-term studies are recommended before this technique is used routinely in clinical practice.

Massive hemoptysis is one of the emergencies in respiratory system, representing hemorrhage of the bronchial or pulmonary vascular system into the respiratory tract. Massive hemoptysis is a life-threatening condition due to high risk of asphyxia it may induce. Bronchial artery embolization (BAE) is an interventional radiology procedure dedicated in the emergency management of massive hemoptysis. BAE is known for its great success rate and low risk of complications. Proper catheterization technique, recognition of bronchial artery variant anatomy and appropriate selection of embolic material agent proves essential in determining the success of this procedure. As a minimally invasive procedure, BAE is highly recommended to be used in cases of massive hemoptysis.

Cognitive functions include the ability to understand, study, perceive and process external information. Among the main causes of cognitive dysfunction we can highlight perinatal damage to the central nervous system or asphyxia, as well as environmental factors. Children have such manifestations of cognitive dysfunction as learning disabilities, motor defects, mixed specific developmental disorders. The most frequent complaint is the decrease of attention concentration, noted in 21 % of children in Ukraine. Cognitive dysfunction is often combined with depression, anxiety, addictive behavior; in almost half of patients, cognitive dysfunctions persist into adult age. Among the mechanisms of development of cognitive dysfunction, the key factors are oxidative stress and low-intensity inflammation in ganglion cells. According to the results of experimental and clinical studies, it has been proved that amino acids asparagine and glutamine, as well as DL-phosphoserine and vitamin B6 as the main components of the combination drug Cogivis contribute to the development of the brain, provide synthesis of proteins, nucleotides, neurotransmitters, glutathione; affect the oxidative stress in the central nervous system, in particular in the hippocampus. All this creates conditions for optimal functioning of neurons and development of cognitive functions.

Victims with fatal and non-fatal closed blunt trauma of the larynx and hyoid bone often become the object of forensic medical service during the pre-judicial and judicial investigation. The purpose of this study is to analyze the features of expert qualification of bodily injuries in victims with closed blunt trauma of the larynx and hyoid bone, depending on the nature and severity to determine ways to unify its forensic diagnosis. Materials and methods. The study was based on the conclusions of 35 forensic medical examinations of cases of closed blunt trauma of the larynx and hyoid bone, obtained from the leading expert institution of the Kharkiv region. Results. We determined the peculiarities of estimating the degrees of severity of above bodily injuries. Severe injuries were found in 12 (34.4%) cases of death of the victims from mechanical asphyxia, in one case of reflex cardiac arrest, and in one case of traumatic shock. Injuries of moderate severity were established by experts in 6 (17.1%) cases of lethal and in 6 (17.1%) cases of non-lethal cases with laryngeal cartilage fractures; in 2 (6.2%) cases of non-lethal injuries with acute oedema, hematoma, laryngeal stenosis of the second degree. 7 (20%) cases of non-lethal laryngeal injuries with further development of acute posttraumatic laryngitis were qualified as simple injuries. Conclusion. There are no clear morphoclinical criteria for objective assessment of injuries of the larynx and hyoid bone that can lead to pre-diagnostic expert errors. According to the results of the work, the ways to unify forensic medical assessment and diagnosis of such injury was determined.

One of the pressing issues of healthcare nowadays is applying methods of molecular genetics aimed at identifying and assessing genetic risk factors and early diagnosis of perinatal pathology. Numerous studies have contributed to identifying risk factors that affect the health of newborns. The aim of this work is to investigate the associations between the development of perinatal pathology in premature and full-term infants with polymorphism of genes of the glutathione transferase family (GSTT1, GSTM1, GSTP1), renin-angiotensin system (ACE, AGT2R1). Materials and methods. The study included 110 full-term infants with asphyxia, 30 healthy full-term infants for the control group, and 125 preterm infants with perinatal infections, 21 preterm infants with broncho-pulmonary dysplasia, and 70 conditionally healthy preterm infants. A set of routine clinical and laboratory methods of research and determining gene polymorphism was performed. Results. The presence of a non-functional allele of the GSTT1 gene and DD variant of the ACE gene in newborns is associated with the development of severe perinatal asphyxia (p = 0.006 and p = 0.003, respectively). Children with GSTT1 "-" and AC AG2TR1 genotypes have significantly higher levels of diastolic pressure in the first day after birth than children with functional genotypes of these genes (p

This study comprehensively examines clinical symptoms, laboratory findings, and placental pathology in 40 cases of singleton full-term SARS-CoV-2 negative neonates. Their mothers, previously healthy, with uncomplicated pregnancies, were infected peripartum and presented COVID-19 symptoms of various severity. Neonates had predominately diarrhea, the yet unreported absent sucking reflex, elevated COVID-19 inflammatory and ischemia/asphyxia markers as serum ferritin, interleukin-6 and cardiac troponin-T, while placentas demonstrated mild vascular and/or inflammatory lesions. We hypothesize that the above placental lesions may be associated with transient perinatal hypoxia resulting in absent sucking reflex, as well as with inflammatory cytokines transfer causing diarrhea.

Mg supplementation has been shown to protect preterm fetuses from white and gray matter damage, but the mechanism is unclear. The purpose of this study was to study the effect of maternal inflammation on the overall protein panel of the fetal rat brain, as well as the neuroprotective effect of magnesium-sulfate (MG). Pregnant rats at e20 (n = 6, 18 total) received injections of i.p. lipopolysaccharide (LPS) 500 ug/kg or control saline (SAL) at time 0. Dams were randomized to treatment with s.c. MG (270 mg/kg loading followed by 27 mg/kg q20 min) or saline (SAL) from −2 to +2 h, followed by an additional injection of MG (270 mg/kg) at +2 h. At 4 h after LPS administration, fetal brains were collected from the 3 treatment groups (LPS/SAL, LPS/MG, SAL/SAL) and analyzed by proteomic technique. LPS significantly decreased fetal brain complement C3, alpha-1-antiproteinase, metallothionein-3, alpha-2-macroglobulin, neurosecretory protein VGF, glutathione S-transferase mu 2, fam91a1, cnot7, mitogen-activated protein kinase levels, and significantly increased fetal brain Hbg1, while MG treatment normalized these measures to normal values. Maternal inflammation may cause brain injury via pathways other than the activation of neurotoxic cytokines; this effect could be due to increased/decreased production of certain proteins associated with securing oligodendrocytes, encouraging neuronal growth in the brain, or protecting against cerebral ischemia. MG’s neuroprotective activity may be achieved by modifying the effect of LPS on proteins involved in early brain development.

The study focused on the application value of classification algorithms in processing CT images of acute respiratory distress syndrome (ARDS) and aimed to analyze the pathogenic factors of ARDS. A total of 60 ARDS patients in hospital were selected, and they were divided into ARDS group (38 cases) and non-ARDS group (22 cases) as per diagnostic criteria. There was no significant difference in general data between the two groups ( P > 0.05 ). The FWAC algorithm was introduced into CT imaging to classify the image data more accurately. The two groups were compared for the left ventricular ejection fraction (LVEF), oxygenation index PaO2/FiO2 (P/F), Acute Physiology and Chronic Health Evaluation (APACHE II) scores, pH, and PaO2. The results showed that the PaO2, P/F, and APACHE II scores of the two groups were not statistically significant ( P > 0.05 ). The P/F of the ARDS group was 136.12, and that of the non-ARDS group was 143.04; the APACHE II score of the ARDS group was 40.1, and that of the non-ARDS group was 62.3, showing no significant difference ( P > 0.05 ); the LVEF of the ARDS group was 58.14, and that of the non-ARDS group was 46.26, showing statistically significant differences ( P > 0.05 ). When the minimum support was 0.3 and the minimum confidence was 0.5, the value of Recurrence was 0.7082 and the value of Diagnosis was 0.968. The rules generated by the FWAC algorithm can accurately predict the category and were consistent with the expected results. The accuracy of this algorithm was as high as 98.7%, which was significantly higher than that of the conventional CT imaging (88.4%). The rules generated by FWAC were more accurate, assisting doctors in the prevention and diagnosis of ARDS disease. Premature delivery and asphyxia are high-risk factors of ARDS. In conclusion, the FWAC algorithm has a good classification ability of the CT images of ARDS and demonstrates high accuracy.

To establish the demographics, injury patterns, management and outcomes of paediatric major trauma patients at Cork University Hospital (CUH). This was a retrospective, descriptive study. Data from all CUH paediatric major trauma cases that were recorded in the Trauma Audit and Research Network (TARN) database from January 2014 to July 2018 were examined. All patients were under the age of sixteen and fulfilled NOCA’s Major Trauma Audit inclusion criteria (Appendix). A total of 163 patients were included, with a mean age of 9 years (standard deviation 4.8 years); 33% (n = 54) had an Injury Severity Score (ISS) > 15. The majority (62%) was male. Paediatric trauma accounts for 6% of TARN eligible cases at CUH. The most common mechanism of injury was falls

OBJECTIVES To investigate the activity of key rate-limiting enzymes of glucose metabolism after restoration of spontaneous circulation (ROSC), to explore the potential pathophysiological mechanism of impaired myocardial energy metabolism after cardiopulmonary resuscitation (CPR). METHODS Twenty-one male Sprague-Dawley rats were randomized into three experimental groups assigned in accordance with different observation times after ROSC: 1) Sham, instrumented rats without induced cardiac arrest or resuscitation; 2) Post-resuscitation (PR2 h); 3) PR24 h. In these groups, CPR, including precordial compressions and synchronized mechanical ventilation, was initiated 6 min after asphyxia-induced cardiac arrest. Hearts were harvested after ROSC and samples were used to detect high-energy phosphate and glucose metabolic enzyme activity. RESULTS Compared with sham, the contents of phosphocreatine and adenosine triphosphate reduced in the PR2 h group, while remained unchanged in the PR24 h group. Activities of hexokinase and pyruvate kinase did not change after ROSC. Phosphofructokinase activity decreased only in the PR24 h group. Activities of pyruvate dehydrogenase and citrate synthase fell in PR2 h group and recovered in the PR24 h group. However, isocitrate dehydrogenase and α-ketoglutarate dehydrogenase activities fell in the PR2 h group, but did not recover in the PR24 h group. CONCLUSIONS Lowered key rate-limiting enzymes activity in glucose metabolism resulted in impairment of energy production in the early stage of ROSC, but partially recovered in 24 h. This process has a role in the mechanism of impaired myocardial energy metabolism after CPR. This investigation might shed light on new strategies to treat post resuscitation myocardial dysfunction.

PROM was one of the factors causing asphyxia neonatorum, oligohydramnios can caused retroplacenter circulation disorders. Other risk factor are preterm delivery and posterm delivery. A dangerous threat to preterm babies is difficulty in breathing because the lungs and respiratory system have not work perfectly. This research to determine the correlations between premature rupture of membranes and gestational age with the incidence of asphyxia neonatorum in the maternal room of KRT Setjonegoro Wonosobo Hospital. This research was an analysis correlations with an observational design and using a retrospective approach. The sample was newborn babies as many as 184 respondents with a simple random sampling technique. The data analysis methods in this research used the Chi-Square test. The results of bivariate analysis between premature rupture of membranes and the incidence of asphyxia neonatorum showed a ρ value of 0,000, gestational age with the incidence of asphyxia neonatorum showed a ρ value of 0,000. There is a correlations between premature rupture of membranes and gestational age with the incidence of asphyxia neonatorum. It was recommended for pregnant women to be active in seeking information about the impact of asphyxia. Researcher expected to always increase knowledge about PROM, preterm and posterm pregnancy.

Introduction: External and internal autopsy findings of suicidal hanging were evaluated retrospectively in Muğla, Turkey. The relations between macroscopic autopsy findings and age, gender, nature of the ligature, position of the knot, and the ligature marks were assessed. The aim of this study was to describe autopsy findings of the hangings and discuss the regional differences. Method: The reports of 175 hanging autopsies between 2013 to 2018 were evaluated retrospectively. Macroscopic external and internal findings were evaluated and compared statistically. Results: Among the 2534 autopsies, the cause of death was suicide by hanging in 175 cases (6.9%). The male-to-female ratio was 3:1, 76%(n = 133) of the cases were male, 24% (n = 42) were female, the mean age was 44.9(SD = 19.3) years. Suicide by hanging was most prevalent in the 25–44 age group and among men. Complete hanging was more common than incomplete hanging, and softer materials were more commonly used in incomplete hangings. Females utilized soft materials more than males. Males used atypical hanging more than females. Bilateral hemorrhage in the neck muscles was more common with typical hanging. There was a significant relationship between tongue protrusion and hemorrhage at the clavicular head of sternocleidomastoid muscle. Conclusion: In this study, which includes a large series, some regional and gender differences were observed. Careful and detailed macroscopic examination was important to diagnose antemortem vitality findings.

RESUMEN Para describir los signos que se pueden encontrar en una autopsia, cuya causa demuerte es asfixia por ahorcadura o por estrangulamiento; se desarrolló esta revisiónteórica, en la que se incluyeron 26 publicaciones, desde 2010 hasta la actualidad. Elahorcamiento, es una de las principales formas de suicidio, más frecuente entre loshombres; mientras que el estrangulamiento, ocurre más entre las mujeres; y su victimario suele tener vínculos amorosos o familiares con esta. El conocimiento de los signosexternos e internos en ambas causas de muerte, resulta de vital importancia para elmédico forense.

Background Birth asphyxia is a leading cause of neonatal brain injury, morbidity, and mortality globally. It leads to a multi-organ dysfunction in the neonate and to a neurological dysfunction called Hypoxic Ischemic Encephalopathy (HIE). Cooling therapy is commonly used to slow or stop the damaging effects of birth asphyxia. However, most of the cooling devices used in the healthcare facility do not have a rewarming functionality after cooling therapy. A separate rewarming device, usually a radiant warmer or incubator is used to rewarm the infant after therapy, causing additional burden to the healthcare system and infant families. The objective of this project was, therefore, to design and develop a cost-effective and efficient total body cooling and rewarming device. Methods Our design includes two water reservoirs that operate by pumping cold and warm sterile water to a mattress. After decreasing the infant’s core body temperature to 33.5 °C, the system is designed to maintain it for 72 h. Feedback for temperature regulation is provided by the rectal and mattress temperature sensors. Once the cooling therapy is completed, the system again rewarms the water inside the mattress and gradually increases the neonate temperature to 36.5–37 °C. The water temperature sensors’ effectiveness was evaluated by adding 1000 ml of water to the reservoir and cooling and warming to the required level of temperature using Peltier. Then a digital thermometer was used as a gold standard to compare with the sensor’s readings. This was performed for five iterations. Results The prototype was built and gone through different tests and iterations. The proposed device was tested for accuracy, cost-effectiveness and easy to use. Ninety-three point two percent accuracy has been achieved for temperature sensor measurement, and the prototype was built only with a component cost of less than 200 USD. This is excluding design, manufacturing, and other costs. Conclusion A device that can monitor and regulate the neonate core body temperature at the neuroprotective range is designed and developed. This is achieved by continuous monitoring and regulation of the water reservoirs, mattress, and rectal temperatures. The device also allows continuous monitoring of the infant’s body temperature, mattress temperature, reservoir temperature, and pulse rate. The proposed device has the potential to play a significant role in reducing neonatal brain injury and death due to HIE, especially in low resource settings, where the expertise and the means are scarce.

Background:Birth asphyxia and resultanthypoxic ischemic encephalopathy (HIE), are leading cause of mortality and morbidity in newborns. Delayed diagnosis may lead to progression of HIE as its clinical features may not be evident at birth as they evolve with time. This study was done to identify asphyxia and HIE in term neonates by evaluating biochemical and oxidative stress markers in umbilical cord blood sample taken immediately after delivery. Methodology: This prospective cross sectional study was done on term neonates in a tertiary care hospital (n=60)Thestudy population was then divided into two equal groups on the basis of Apgar score at 1 minute, with score < 7 as cases (n=30) and ≥7 as controls ( n=30) . The umbilical cord blood was evaluated for biochemical and oxidative stress markers like lactate dehydrogenase (LDH), creatine kinase brain isoform (CK BB), superoxide dismutase (SOD,malondialdehyde (MDH) and catalase. Result: The mean values of LDH, CK BB, and MDA were higher in cases than controls and the differences were highly significant statistically. The mean values of SOD and catalase were higher in cases than controls and the differences were significant statistically. However, mean value of LDH & CKBB of cases with prolonged asphyxia with Apgar score < 7 at 5 minutes (n=4) versus cases with Apgar score > 7 (n=26) was not statistically significant at 95% CI. Conclusion: This study helps in diagnosis of neonatal asphyxia at an early stage thereby preserving the normal functioning of neonatal brain so that the brain functioning is not compromised.

This study aims to review the global mortality secondary to laryngeal edema in patients diagnosed with hereditary angioedema and their relatives over the years, as well as to describe epidemiological and clinical findings associated with this outcome. An extensive search of the literature was made in PubMed, Scopus, and Embase to identify mortality rates secondary to laryngeal edema in patients with hereditary angioedema. The search was carried out in September of 2020 and in April of 2021, and keywords based on the MeSH terms were searched in three databases. The filter of language was used for finding only articles in English, and there was no limit to the year of publication. A total of twenty-three articles fulfilled the inclusion criteria for review and data extraction. The analyzed studies included 3292 patients and 411 deaths from asphyxia due to laryngeal edema. One hundred and three deaths in close relatives were described as secondary to the same cause. The main findings were summarized in tables: year and place of publication, the number of patients and deaths from laryngeal edema, patients previously diagnosed, and death age. Death rates from laryngeal edema had an average of one death for every 20 patients. Eight studies reported deaths in relatives. For every 7.4 patients in these studies, one relative died. The percentage among deaths in general associated with laryngeal edema was evaluated in three studies (32.7%, 44.4%, and 56%). The high frequency of this outcome suggests that deaths still occur, and improvement of hereditary angioedema treatment still needs to be met.

This article proposes that machine learning can break through the technical limitations of the linear growth test for the early physique of infants smaller than gestational age and can accurately calculate and predict the consequences of the disease. For testing the linear growth of the early physique of infants smaller than gestational age, the data collection and judgment are carried out according to the computer analysis method. Experimental results show that 47.3% of infants younger than gestational age may have suffocation. The experimental subjects designed in this study are small-for-gestational-age infants who were hospitalized in the neonatal intensive care unit from January 2020 to January 2021. According to the relationship between gestational age and birth weight, the survey subjects were divided into two groups: early group and late group. Male and female small-for-gestational-age infants accounted for 68% and 32%, respectively. Among them, the proportion of early gestational age was the most, with more boys than girls, and sick singleton was more than twins. In the early group, the incidence was 52.1% for neonatal asphyxia, 22.5% for feeding intolerance, 14.8% for intracranial hemorrhage, 6.3% for scleredema, 24.7% for neonatal hyperbilirubinemia, 24.6% for hypoglycemia, 1.1% for apnea, and 3.2% for respiratory distress syndrome. Infants develop differently at different stages of corrected gestational age. The incidence of low body weight (6%) after correction for 3 months was significantly reduced compared with correction for gestational age, and the difference was statistically significant ( P

BACKGROUND: Drowning is one type of asphyxia caused by the entry of fluid into the airway. Death due to drowning is one of the hardest things that are difficult to diagnose in the field of forensic medicine, primarily if the victim found to be in a decomposed state. The state of decomposed examination often does not show typical signs. The diagnosis of drowning can be reached after considering all the results of the forensic examination including external, internal, and laboratory examinations. CASE PRESENTATION: A body has been found in the residential area on the east side of the beach, Tambaksarioso Village, Asemrowo District, on Tuesday, May 18, 2021, at 13.30 West Indonesian Time and reported to the police for investigation. The body was then identified at Dr. Soetomo General Hospital by a forensic expert. External, internal, and laboratory investigations were conducted. On external examination, the corpse was not intact, with signs of decay, saponification, and violation. In an internal examination, sand in the airways and other signs of drowning were identified. In the acid destruction test using the right femur, a positive diatom result was obtained. CONCLUSION: A complete autopsy is vital to determine the cause and mechanism of death, reconstruct the events before death, and identify the victim. It is also essential to determine whether the deceased died by drowning was alive before entering the water. All injuries suffered by the victims should be described.

BACKGROUND: Neonatal bacterial meningitis has a significant contribution on neonatal morbidity and mortality. It is the most common complication of late-onset neonatal sepsis. An understanding of the risk factors for bacterial meningitis in late-onset neonatal sepsis is required to provide comprehensive management. AIM: To identify the risk factors of bacterial meningitis in late-onset neonatal sepsis. METHODS: This is an analytical study with a case–control design, conducted in May 2019-February 2021, involving neonates aged 4–28 days who suffered from late-onset neonatal sepsis in Level II and III Neonatal Care Unit, Sanglah General Hospital Denpasar. Statistical analysis was performed using Chi-square and logistic regression. RESULTS: A total of 54 patients were analyzed in this study. The mean age of subjects with neonatal bacterial meningitis was 13 days and the majority of them were male (51.9%). The risk factor of bacterial meningitis in late-onset neonatal sepsis was gestational age

Asphyxia neonatorum is the failure of the newborn to breathe spontaneously and regularly, causing further disturbances. The onset of asphyxia in infants with pre-eclamptic mothers is due to high blood pressure causing reduced blood delivery to the placenta, this will reduce the supply of oxygen and food for the baby. As a result, the baby's development is slow, and intrauterine hypoxia occurs. The purpose of this study was to determine the correlation between pre-eclampsia in pregnancy and the incidence of asphyxia neonatorum in the NICU Room of the Mataram City Hospital, NTB in 2020. The research method used in this study was analytical correlational with a case control design with a retrospective time approach. The population is the data of all women giving birth in the NICU Room of Mataram City Hospital in 2020 as many as 1,098 people. The sampling technique used was systematic random sampling so that the number of samples obtained was 124 samples. The tools used are medical records. The statistical analysis used was the chi square test. The results showed that of the 124 samples studied, the neonatal asphyxia infants in mothers with pre-eclampsia were 39 (62.9%) compared to 23 (37.1%) non-preeclamptic mothers, the results of the probability value (p value) = 0.000

Hereditary angioedema is a rare (orphan) disease associated with the development of angioedema of various localization caused by the action of bradykinin. The main symptoms of the disease are peripheral angioedema, abdominal attacks (accompanied by severe pain syndrome), edema of the upper respiratory tract, which may lead to asphyxia and death of the patient. Peripheral edema disrupts social and professional activity, the occurrence of facial edema complicates social adaptation, the unpredictability and potential threat to life of edema in the larynx, as well as the lack of effect from standard (systemic glucocorticoid and antihistamines) therapy regimens lead to a low quality of life of patients, a large number of days of disability, hospitalizations, in some cases, premature death of patients. According to international studies, on-demand therapy does not reduce the burden of the disease, and therefore international guidelines emphasize the importance of timely and individualized selection of long-term prevention for patients with hereditary angioedema. Taking into account the appearance of a new drug for long-term prevention in Russia, an Expert Council was held to assess the burden of the disease in Russian patients, determine the proportion of patients who need long-term prevention, criteria for choosing a medication for prophylaxis and the place of Lanadelumab in it.

To examine the frequency of placental abnormalities in a multicenter cohort of newborn infants with hypoxic-ischemic encephalopathy (HIE) and to determine the association between acuity of placental abnormalities and clinical characteristics of HIE.Infants born at ≥36 weeks of gestation (n = 500) with moderate or severe HIE were enrolled in the High-dose Erythropoietin for Asphyxia and Encephalopathy Trial. A placental pathologist blinded to clinical information reviewed clinical pathology reports to determine the presence of acute and chronic placental abnormalities using a standard classification system.Complete placental pathologic examination was available for 321 of 500 (64%) trial participants. Placental abnormalities were identified in 273 of 321 (85%) and were more common in infants ≥40 weeks of gestation (93% vs 81%, P = .01). A combination of acute and chronic placental abnormalities (43%) was more common than either acute (20%) or chronic (21%) abnormalities alone. Acute abnormalities included meconium staining of the placenta (41%) and histologic chorioamnionitis (39%). Chronic abnormalities included maternal vascular malperfusion (25%), villitis of unknown etiology (8%), and fetal vascular malperfusion (6%). Infants with chronic placental abnormalities exhibited a greater mean base deficit at birth (-15.9 vs -14.3, P = .049) than those without such abnormalities. Patients with HIE and acute placental lesions had older mean gestational ages (39.1 vs 38.0, P .001) and greater rates of clinically diagnosed chorioamnionitis (25% vs 2%, P .001) than those without acute abnormalities.Combined acute and chronic placental abnormalities were common in this cohort of infants with HIE, underscoring the complex causal pathways of HIE.ClinicalTrials.gov: NCT02811263.

Background Guidelines for neonatal resuscitation recommend a 3:1 compression to ventilation ratio. However, this recommendation is based on expert opinion and consensus rather than strong scientific evidence. Our primary aim was to assess whether continuous chest compressions with asynchronous ventilations would increase return of spontaneous circulation (ROSC) rate and survival compared to the 3:1 chest compression to ventilation ratio. Methods This was a prospective, randomized, laboratory study. Twenty male Landrace-Large White pigs, aged 1–4 days with an average weight 1.650 ± 228.3 g were asphyxiated and left untreated until heart rate was less than 60 bpm or mean arterial pressure was below 15 mmHg. Animals were then randomly assigned to receive either continuous chest compressions with asynchronous ventilations (n = 10), or standard (3:1) chest compression to ventilation ratio (n = 10). Heart rate and arterial pressure were assessed every 30 s during cardiopulmonary resuscitation (CPR) until ROSC or asystole. All animals with ROSC were monitored for 4 h. Results Coronary perfusion pressure (CPP) at 30 s of CPR was significantly higher in the experimental group (45.7 ± 16.9 vs. 21.8 ± 6 mmHg, p Conclusion Continuous chest compressions with asynchronous ventilations significantly improved CPP, ETCO2, time to ROSC, ROSC at 30 s and survival in a porcine model of neonatal resuscitation.