Neuro-developmental status of children with congenital hypothyroidism: experience in a tertiary hospital of Bangladesh

Background: Congenital hypothyroidism is one of the most common preventable causes of mental retardation. Early diagnosis and initiation of treatment is fundamental for optimal neuro-developmental outcome in children with congenital hypothyroidism. Thyroid hormones play crucial role in early neuro-development especially in the first 2-3 years of life. If left untreated or delayed initiation of treatment in congenital hypothyroidism results in neurological and psychological deficits. Aim of this study was to assess neuro-developmental status of children with congenital hypothyroidism who were on treatment (levo-thyroxine) started at different ages. Methods: This cross-sectional study was done at paediatric endocrine outpatient department (OPD) and child development centre (CDC), BIRDEM General Hospital. Children with congenital hypothyroidism presenting at different ages who were followed up at pediatric endocrine OPD between January 2014 and January 2015 were included in the study.Their functional status in different domains were studied by rapid neuro-developmental assessment (RNDA) in CDC. Children with Down syndrome and perinatal asphyxia were excluded. Results: Neuro-developmental assessment was done in 34 children (male 21, female 13). Mean age during assessment was 36 months (standard deviation 18.56). Eighteen patients (53%) were diagnosed in BIRDEM General Hospital and rest 16 (47%) were diagnosed outside BIRDEM General Hospital. Patients were grouped into 4 on the basis of age of diagnosis and start of treatment: group I (age 0-1 month), n=6 (18%); group II (age >1-3 months), n=7 (21%); group III (age >3-12 months), n=9 (26%); group IV (age >12months), n=12 (35%). In group I, five (84%) had normal development and one had mild delay in cognition. In group II, three (43%) had normal development. Cognition and behavior was delayed in 3 patients (43% each), followed by delay in speech in 2 (29%). All patients (100%) in group III and IV had developmental delay, predominant domains affected were speech, cognition and behavior. Conclusion: We have found developmental delay especially in the domain of speech, cognition and behavior in children with congenital hypothyroidism who have started levo-thyroxin late. Early diagnosis and initiation of treatment is fundamental for optimal neuro-developmental outcome in children with congenital hypothyroidism. Birdem Med J 2021; 11(1): 63-66

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Early diagnosis and misdiagnosis of Glaucoma

Annals of King Edward Medical University ◽

10.21649/akemu.v12i2.870 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Ghulam Sabir

Keyword(s):

Intraocular Pressure ◽

Early Diagnosis ◽

Early Stage ◽

Visual Fields ◽

Fundus Examination ◽

Group Iii ◽

Group I ◽

Initial Stage ◽

Diagnosis Method ◽

First Time

Aim: To recognize and draw a line between glaucomatous and non glaucomatous patients at very early stage. Objects: Such silent dangerous ocular problem must be recognized and treated at very initial stage to avoid subsequent complications. Diagnosis: History and all the parameters including intraocular pressure, vision, visual fields and fundus examination were evaluated for diagnosis. Method of study: The study was done at General Hospital and Services Hospital Lahore from 1987 to early 1991. All the patients over the age of 40 year whether coming for first time or already on antiglaucoma treatment were evaluated thoroughly. Patients were examined by senior colleagues also. Results: Total 180 patients were included in study, 120 males 60 females. They were divided into four groups. Group I and II were diagnosed early and included 120 patients with no complications. Group-III and IV were misdiagnosed and included 60 patients. Discussion Until and unless, special care is taken to focus on the diagnosis, it is usually missed with many complications. It is only the casual behaviour of treating physician who considers the patient`s complaint lightly and examines them superficially. Conclusion: Although misdiagnosed cases are relatively less than truly misdiagnosed cases of glaucoma yet they form an important fraction of patients who may go blind within coming years. It is therefore necessary to diagnose such patients at very early stage. The surgeon should take special interest to diagnose such patients. One should not hesitate to consult senior colleagues in doubtful cases. Proper counseling for non cooperative patients is very necessary.

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Tracheobronchial Foreign Bodies in Children: A Strong History Associated with Plain Chest Radiography Findings Leads to Bronchoscopy

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2021.56823 ◽

2021 ◽

Author(s):

Umut Alıcı ◽

Çiğdem Öztunalı ◽

Çiğdem Arslan Alıcı ◽

Hüseyin İlhan ◽

Baran Tokar

Keyword(s):

Early Diagnosis ◽

Group Structure ◽

Delayed Diagnosis ◽

Diagnostic Tools ◽

X Ray ◽

Group Iii ◽

Diagnosis Group ◽

Group I ◽

Breath Sounds ◽

Chest X Ray

Objective: History and chest x-ray are the main diagnostic tools in children with foreign body aspiration (FBA). The study aims to evaluate clinical, radiological, and bronchoscopic findings associated with early and delayed diagnosis of FBA. Methods: The records of 249 children having bronchoscopy for suspected FBA were analyzed in three groups as negative bronchoscopy for FBA (group I), early diagnosis (group II), and delayed diagnosis (group III). Results: Choking episodes, coughing, and decreased breath sounds were determined significantly in FBA. The percentage of radiopaque FBs was 6.2%. Emphysema in groups II and III; atelectasis and pneumonia in group III were significantly higher on chest x-ray. Pneumonia and significant inflammation found during bronchoscopy were prominent in group III. FBs were mostly vegetable origin and the majority were found in the bronchus, more on the right side. FBs were successfully removed by rigid bronchoscopy except one having thoracotomy. Conclusion: Review of the literature, our current (2010-2019) and previous (1994-2003) studies designed in the same group structure showed that choking episode associated with a radiopaque FB leads to bronchoscopy. Emphysema and atelectasis are also valuable for early diagnosis. Regardless of radiological findings, bronchoscopy should be considered in patients with a strong history.

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How different levels of virtual reality influence Anxiety, Behavior and Oral Health Status in preschool children: A Randomized Controlled Clinical Trial (Preprint)

10.2196/preprints.35415 ◽

2021 ◽

Author(s):

Naser Aslaminabadi ◽

Ozra Golsanamlou ◽

Zohreh Halimi ◽

Zahra Jamali

Keyword(s):

Virtual Reality ◽

Oral Health ◽

Oral Health Status ◽

Group Iv ◽

Plaque Index ◽

Group Iii ◽

Group I ◽

Anxiety Behavior ◽

And Behavior ◽

Different Levels

BACKGROUND Compared with traditional behavior management strategy and oral health training, virtual reality (VR) integrated with multisensory feedback possesses potentials advantages in dentistry. OBJECTIVE This study aimed to assess the impact of different levels of VR on anxiety, behavior and oral health status. METHODS Sixty healthy children aged 4-6 years were randomly assigned into four groups, each consisting of 15 children. The study consisted of 2 consecutive sessions. During the first visit, plaque index was calculated and oral health education was carried out in all groups using Immersive VR (group I), Semi-immersive VR (group II), Non-immersive VR (group III) and Tell-Show-Do (group IV). In the second session, an amalgam restoration was performed in all groups. Subject’s anxiety and behavior was recorded using MCDAS (f) Questionnaire and Frankl Scale. Plaque index recorded in two follow-up sessions. RESULTS The most prevalence of positive behavior (P=0.004) and the lowest anxiety (p<0.001) was recorded in group I, followed by group II, group III and group IV. The plaque index scores showed a reduced trend (P<0.001), but the values did not differ significantly between the four groups (P=0.205). CONCLUSIONS This study offers evidence on the beneficial impact of different levels of VR meditation on anxiety and behavior. CLINICALTRIAL IR.TBZMED.REC.1400.292

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Surgical treatment of lumbar disc herniation in Aceh, Indonesia: description in 28 patients

Journal of Health Sciences ◽

10.17532/jhsci.2017.433 ◽

2017 ◽

Vol 7 (2) ◽

pp. 132-136

Author(s):

Jonny Karunia Fajar ◽

Azharuddin Azharuddin

Keyword(s):

General Hospital ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Age Group ◽

Common Procedure ◽

Group Iii ◽

Group I ◽

Over 40 Years ◽

Banda Aceh

Introduction: Several studies have reported the incidence of herniated nucleus pulposus (HNP) in some hospitals. Surgery is one of the options in HNP management. HNP surgery results in Aceh have not been reported yet. Therefore, this study reported the HNP surgery in Zainoel Abidin General Hospital, Banda Aceh period 2010-2012. Methods: This was a descriptive retrospective survey conducted in Zainoel Abidin General Hospital Banda Aceh at August-September 2012. Results: The incidence of HNP who underwent surgery was 28 patients. There was no HNP case in the age group I (0-18 years), seven patients (25%) were age group II (19-40 years), and 21 patients (75%) were age group III (over 40 years). Based on HNP location, no HNP located in the L1-L2 and L3-L4, one patient (3.57%) was L2-L3, 20 patients (71.42%) were L4-L5, three patients (10.71%) were L5-S1, and there were four HNP patients in multiple lumbar (14.28%). Laminectomy was the most common type of surgery performed (27 patients or 96.42%), followed by laminotomy (one patients or 3.57%). Conclusion: There was significant association between the incidence of HNP with age, but not with gender. In summary, the most common lumbar disc herniation was in L4-L5. Laminectomy was the most common procedure performed in HNP patient in Aceh.

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Ultrastructural Lesions Produced by Alcohol and Sucrose in the Heart and Liver of C57BL Mice

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100068035 ◽

1970 ◽

Vol 28 ◽

pp. 208-209

Author(s):

K.K. SEKHRI ◽

C.S. ALEXANDER ◽

H.T. NAGASAWA

Keyword(s):

Osmium Tetroxide ◽

Male Mice ◽

Alcohol Group ◽

Group Iii ◽

Group I ◽

C57bl Mice ◽

Group Ii

C57BL male mice (Jackson Lab., Bar Harbor, Maine) weighing about 18 gms were randomly divided into three groups: group I was fed sweetened liquid alcohol diet (modified Schenkl) in which 36% of the calories were derived from alcohol; group II was maintained on a similar diet but alcohol was isocalorically substituted by sucrose; group III was fed regular mouse chow ad lib for five months. Liver and heart tissues were fixed in 2.5% cacodylate buffered glutaraldehyde, post-fixed in 2% osmium tetroxide and embedded in Epon-araldite.

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The Quantitative Ultrastructure of the Heart Muscle of Japanese Quail by Hypergravitation, Hypodynamy and Combination

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100158480 ◽

1990 ◽

Vol 48 (3) ◽

pp. 188-189

Author(s):

Anton Bózner ◽

Mikuláš Gažo ◽

Jozef Dostál

Keyword(s):

Japanese Quail ◽

Heart Muscle ◽

Relative Size ◽

Combination Group ◽

Control Group ◽

Group V ◽

Group Iii ◽

Space Flights ◽

Group I ◽

Quantitative Ultrastructure

It is anticipated that Japanese quail /Coturnix coturnix japonica/ will provide animal proteins in long term space flights. Consequently this species of birds is of research interest of international space program INTERCOSMOS. In the year 1987 we reported on an experiment /2/ in which the effect of chronic acceleration of 2 G hypergravitation, the hypodynamy and the simultaneous effect of chronic acceleration and the location in the centre of the turntable of the centrifuge on the protein fractions in skeletal muscles was studied. The ultrastructure of the heart muscle was now in this experiments examined as well.Japanese quail cockerels, aged 48 days were exposed to 2 G hypergravitation /group IV/ in a 6,4 m diameter centrifuge, to hypodynamy /group III/ and their combination /group V/, respectively for 6 days / Fig.1/. The hypodynamy in group III was achieved by suspending the birds in jackets without contact the floor. The group II was located in the centre ofthe turntable of the centrifuge. The control group I. was kept under normal conditions. The quantitative ultrastructure of myocard was evaluated by the methods of Weibel/3/ - this enables to determine the number, relative size and volume of mitochondria volume of single mitochondria, defficiency of mitochondrial cristae and volume of myofibrils.

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Heterogeneity and Immunochemical Properties of Anti-β2-glycoprotein I Autoantibodies

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615218 ◽

1998 ◽

Vol 80 (09) ◽

pp. 393-398 ◽

Cited By ~ 33

Author(s):

V. Regnault ◽

E. Hachulla ◽

L. Darnige ◽

B. Roussel ◽

J. C. Bensa ◽

...

Keyword(s):

Fluid Phase ◽

Anticardiolipin Antibodies ◽

Dual Reactivity ◽

Group Iii ◽

Important Group ◽

Epitope Specificity ◽

Glycoprotein I ◽

Group I ◽

Group Ii ◽

Sufficient Concentration

SummaryMost anticardiolipin antibodies (ACA) associated with antiphospholipid syndrome (APS) are directed against epitopes expressed on β2-glycoprotein I (β2GPI). Despite a good correlation between standard ACA assays and those using purified human β2GPI as the sole antigen, some sera from APS patients only react in the latter. This is indicative of heterogeneity in anti-β2GPI antibodies. To characterize their reactivity profiles, human and bovine β2GPI were immobilized on γ-irradiated plates (β2GPI-ELISA), plain polystyrene precoated with increasing cardiolipin concentrations (CL/β2GPI-ELISA), and affinity columns. Fluid-phase inhibition experiments were also carried out with both proteins. Of 56 selected sera, restricted recognition of bovine or human β2GPI occurred respectively in 10/29 IgA-positive and 9/22 IgM-positive samples, and most of the latter (8/9) were missed by the standard ACA assay, as expected from a previous study. Based on species specificity and ACA results, IgG-positive samples (53/56) were categorized into three groups: antibodies reactive to bovine β2GPI only (group I) or to bovine and human β2GPI, group II being ACA-negative, and group III being ACA-positive. The most important group, group III (n = 33) was characterized by (i) binding when β2GPI was immobilized on γ-irradiated polystyrene or cardiolipin at sufficient concentration (regardless of β2GPI density, as assessed using 125I-β2GPI); (ii) and low avidity binding to fluid-phase β2GPI (Kd in the range 10–5 M). In contrast, all six group II samples showed (i) ability to bind human and bovine β2GPI immobilized on non-irradiated plates; (ii) concentration-dependent blockade of binding by cardiolipin, suggesting epitope location in the vicinity of the phospholipid binding site on native β2GPI; (iii) and relative avidities approximately 100-fold higher than in group III. Group I patients were heterogeneous with respect to CL/β2GPI-ELISA and ACA results (6/14 scored negative), possibly reflecting antibody differences in terms of avidity and epitope specificity. Affinity fractionation of 23 sera showed the existence, in individual patients, of various combinations of antibody subsets solely reactive to human or bovine β2GPI, together with cross-species reactive subsets present in all samples with dual reactivity namely groups III and II, although the latter antibodies were poorly purified on either column. Therefore, the mode of presentation of β2GPI greatly influences its recognition by anti-β2GPI antibodies with marked inter-individual heterogeneity, in relation to ACA quantitation and, possibly, disease presentation and pathogenesis.

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Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review

International Journal of Angiology ◽

10.1055/s-0040-1720970 ◽

2020 ◽

Author(s):

Ahmed Mousa ◽

Ossama M. Zakaria ◽

Mai A. Elkalla ◽

Lotfy A. Abdelsattar ◽

Hamad Al-Game'a

Keyword(s):

Severity Score ◽

Vein Graft ◽

Bypass Surgery ◽

Age Groups ◽

Vascular Injuries ◽

Peripheral Vascular ◽

Group Iii ◽

Mangled Extremity ◽

Group I ◽

End To End

AbstractThis study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 40.5 and 49%, respectively. On the other hand, 10.5% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma (p = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury (p = 0.001). The MESS has a significant correlation to both age groups I and II (p = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.

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Oxygen Fraction Adjustment According to Body Surface Area during Extracorporeal Circulation

The Heart Surgery Forum ◽

10.1532/hsf.1325 ◽

2015 ◽

Vol 18 (3) ◽

pp. 098

Author(s):

Cem Arıtürk ◽

Serpil Ustalar Özgen ◽

Behiç Danışan ◽

Hasan Karabulut ◽

Fevzi Toraman

Keyword(s):

Body Temperature ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Extracorporeal Circulation ◽

Group Iii ◽

Oxygen Fraction ◽

Arterial Blood ◽

Group I ◽

Group Ii

Background: The inspiratory oxygen fraction (FiO2) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO2) to reach hyperoxemic levels (>180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO2 levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO2 levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO2 during cardiac surgery.Methods: After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO2 adjustment strategies applied to the patients in the groups were as follows: FiO2 levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5).Results: Mean PaO2 was significantly higher in Group I than in Group II at T2 and T3 (P = .0001 and P = .0001, respectively); in Group I than in Group III at T1 (P = .02); and in Group II than in Group III at T2, T3, and T4 (P = .0001 for all). Conclusion: Adjustment of FiO2 according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO2 between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO2 levels in concordance with the body temperature in the rewarming period.

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Features of the cervix uteri in women of reproductive age with endometrial polyps and micropolyps

HEALTH OF WOMAN ◽

10.15574/hw.2016.113.108 ◽

2016 ◽

pp. 108-111

Author(s):

T.F. Tatarchuk ◽

◽

D.G. German ◽

Keyword(s):

Reproductive Age ◽

Cervix Uteri ◽

Control Group ◽

Women Of Reproductive Age ◽

Endometrial Polyps ◽

Group Iii ◽

Aggressive Form ◽

Group I ◽

Group Ii ◽

Control Group Group

The article presents the comparative analysis of the state of the cervix in women with endometrial polyps and micropolyps. Patients and methods. The study involved 130 patients aged 18-35 years: 70 patients with endometrial polyps (group I), 30 patients with micropolyps (group II) and 30 patients of the control group (group III). Results. According to the anamnesis of women in the I group were significantly more frequent diseases of the cervix, which corrected physical surgery methods, in particular cryodestruction. In group II, the representatives of these indicators were similar to healthy. Normal colposcopic picture met significantly less frequently in patients and I, and II group. The differences in the incidence of HPV high oncogenic risk in all groups were not statistically significant. Conclusion. Destructive methods used in the detection of any changes in the cervix are often overly aggressive, form scars and contributing to inflamaciones process. In the chain of events leading to the formation of PE, cervical pathology and its correction can take the basic place. Key words: endometrial polyp, micropolyps, chronic endometritis, uterine cervix, colposcopy.

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