Dual X-Ray Image under Neural Network Adopted in Comparison of Efficacy and Safety of Deep Hydrolyzed Protein Milk Powder and Parenteral Nutrition in Intervention of Neonatal Noninfectious Abdominal Distension

Objective. The aim of this study was to explore the application value of double X-ray image based on neural network in comparison of the efficacy and safety of deep-water proteolytic milk powder and parenteral nutrition in the intervention of neonatal noninfectious abdominal distention. Methods. Clinical data of 58 neonates diagnosed with noninfectious abdominal distention were retrospectively analyzed. 2D-3D registration was simplified into two steps by decomposing spatial rigid-body transformation parameters into two planes, including 2D-2D approximate rigid-body registration and single-parameter 2D-3D rigid-body registration. Then, the convolution neural network was used to fit the nonlinear mapping relationship between the residual of X-ray images and the corresponding attitude differences of children, and the residual regression spatial rigid-body transformation parameters of the X-DRR image pairs were obtained. Noninfectious abdominal distention was diagnosed in all neonates, of which 28 neonates were treated with deep hydrolyzed protein milk powder. Another 30 neonates who received parenteral nutrition support were set as control group. All newborns received two weeks of treatment. The total effective rate, birth weight recovery, weight growth rate, intestinal feeding recovery time, and incidence of feeding intolerance were compared between the two groups. Results. Spatial coordinate decomposition using double X-ray can simplify the mapping relationship between spatial coordinate transformation and X-DRR residual image. Compared with the gray level iterative optimization registration algorithm, the registration accuracy and speed were significantly improved. The total effective rate in the treatment group (92.86%) was significantly higher than that in the control group (9%). The recovery time of birth weight, intestinal feeding recovery time, and meconium excretion time were significantly shorter than those in the control group, and the body weight in the treatment group increased faster than that in the control group ( P < 0.05 ). In addition, the incidence of feeding intolerance was 3.57% (1/28) in the treatment group and 36.36% (8/22) in the control group, which was significantly lower than that in the treatment group ( P < 0.05 ). Conclusion. After data training, the network can complete accurate double ray registration in 0.04 s. Deep hydrolyzed protein milk powder had remarkable therapeutic effect on neonates, with no infective abdominal distention, fast recovery, and low incidence of feeding intolerance, which was safe and reliable in clinical application.

A Case Report on Acute Necrotizing Pancreatitis and Nursing Management

Introduction: Necrotizing pancreatitis (NP) is a health problem in which part of pancreas dies. This is because of inflammation or injury. If the dead tissue gets infected, it can cause serious issues. Pancreatitis is inflammation of the pancreas. During recurring attacks of pancreatitis, tissues within pancreas may die and later become infected. This condition is called as acute necrotizing pancreatitis. Case Presentation: A 48 yr old male visited in AVBRH with the chief complaints of pain in epigastric region, recurrent vomiting, and abdominal distention since 7 days. Otherwise client was alright. After undergoing investigations such as complete blood count, liver function test, kidney function test, CT Scan (Computed tomography) and sonography etc. He was diagnosed with Acute Necrotizing Pancreatitis and was admitted to male medi- cine ward No.29. He had past medical history of pain in epigastric region, fever, abdominal distention, since 5days. For these complaints his family members referred him in “Get Life Hospital” at Amravati. He was treated with antibiotics, analgesic, After CT scan, Sonography it was found that there was Acute pan- creatitis. That’s why his family members admitted him at A.V.B.R Hospital for further treatment. Conclusion: These results support nonsurgical management, including early antibiotic treatment, in patients with sterile pancreatic necrosis. Patients respond well to treatment.

Evidence-Based Minireview: Should warfarin or a direct oral anticoagulant be used in patients presenting with thrombosis in the splanchnic or cerebral veins?

Case 1: A 23-year-old female third-year medical student who has no medical history seeks treatment for abdominal distention. She takes an estrogen-containing birth control pill and does not smoke or consume alcohol. Family history is unremarkable. Physical examination is significant for abdominal distention, and an abdominal fluid wave is detected. Complete blood count is normal. Imaging confirms occlusive thrombosis of the main portal vein. On endoscopy, grade 1 to 2 esophageal varices are noted and banded. Unfractionated heparin is begun. Subsequent workup reveals a homozygous factor V Leiden mutation. Long-term anticoagulation is planned, and she asks if warfarin can be avoided given her hectic ward rotations, erratic diet, and need for monitoring. Case 2: A 35-year-old woman who has no medical history seeks treatment for progressively worsening posterior headaches for 1 week. Magnetic resonance imaging of the brain shows dural sinus thrombosis with associated small areas of petechial cerebral hemorrhage. She is started on a continuous unfractionated heparin infusion and admitted to the hospital for further observation. Her grandmother is on warfarin for atrial fibrillation, and the patient would prefer to avoid warfarin because she does not think she can comply with the frequent monitoring that will be required. She inquires about other oral anticoagulant options for her condition.

Evaluation of diagnostic factors used to refer children with constipation for rectal biopsies

Purpose Children with constipation and suspected Hirschsprung’s disease are referred for rectal biopsy. Since this is an invasive procedure, appropriate indications should be applied to minimize the number of “unnecessary” biopsies. Methods We reviewed all constipated children who underwent a rectal biopsy to diagnose a possible Hirschsprung’s disease at a tertiary referral hospital over a 6-year period (2013–2018). We registered clinical and demographic factors in these children and conducted correlation and multivariate regression analysis to evaluate the relation between these factors and a diagnosis of Hirschsprung’s disease. Results We identified 225 children, aged 0–17 years. In total, Hirschsprung’s disease was diagnosed in only 49/225 (22%). Among the 49 children with Hirschsprung’s disease, 29 (59%) were diagnosed in the neonatal period. Among girls, HD was confirmed in only 10/101 (10%) children, and only 1 of these 10 girls was older than 6 months at the time of the biopsy. The following factors correlated significantly with Hirschsprung’s disease diagnosis in children older than 1 month: “male sex”, “failure to thrive”, “gross abdominal distention plus vomiting” and “fulfils the Rome 4 criteria for functional constipation”. Conclusion In children referred for rectal biopsy, the factors most indicative of Hirschsprung’s disease were “male sex”, “failure to thrive”, “gross abdominal distention plus vomiting” and “fulfils the Rome 4 criteria for functional constipation”. Notably, the prevalence of Hirschsprung’s disease decreased with the increasing age of the children. Girls referred for a biopsy rarely had Hirschsprung’s disease, especially those older than 1 month.

CONGENITAL COLONIC ATRESIA PRESENTING AS PNEUMOPERITONEUM: A RARE CLINICAL ENTITY

Introduction:Colonic Atresia is the least common type of Intestinal Atresia which occurs as a result of ischemic necrosis of a segment of large intestine.It presents with abdominal distention,bilious vomiting and failure to pass meconium.Perforation leads to peritonitis and sepsis Case Report:We describe a 3 day old male baby presenting with Colonic Atresia type IIIa and pneumoperitoneum and his surgical management Conclusion:In conclusion, Colonic Atresia is managed by either by colostomy or primary anastomosis.Terminal ileostomy,as in this case is done when there is Ascending Colon atresia with distal ileal perforation.

703. Peritoneal Coccidioidomycosis in a Pediatric Patient: An Extremely Rare Presentation and Literature Review

Background Chronic peritonitis is an unusual manifestation of coccidiomycosis (CM) that is challenging to diagnose and manage due to its propensity for relapse. It is even more unusual to diagnose peritoneal CM in the pediatric population, with only two other cases reported in the literature. Methods We present the case of a previously healthy 5-year-old Filipino female in Florida who was diagnosed with peritoneal CM. After months of unintentional weight loss and worsening abdominal distention, she presented to medical care. Imaging revealed significant abdominal ascites and nodularities throughout the peritoneum. The peritoneal fluid demonstrated a lymphocytic pleocytosis and infectious workup was benign. CA125 levels were elevated, but peritoneal adenosine deaminase was within normal limits. A biopsy of the affected tissue revealed diffuse granulomas surrounding spherules that were positive on GMS and PAS staining, concerning for CM. Exposure history revealed that she was raised in California and moved to Florida one year prior to presentation. Complement fixation titers were significantly elevated at ≥ 1:512 and immunodiffusion titers were positive. A Coccidioides PCR was sent from the tissue to the Mayo clinic and was positive, and fungal cultures from the tissue grew C. immitis/posadasii. Immunologic workup was reassuring. She was started on oral Fluconazole with rapid resolution of her symptoms. Results Involvement of the peritoneum in CM is extremely rare. Abdominal distention due to ascites is the most common presentation, and the peritoneal fluid is typically exudative. Imaging may reveal peritoneal deposits which can mimic other infections and malignancy. Diagnosis can be based on histopathological demonstration of fungal structures, cultures, antibody testing, antigen detection and/or PCR. Treatment guidelines suggest azole therapy for nonmeningeal disseminated CM with at least 6–12 months of treatment for extrapulmonary coccidioidal soft tissue infection. Conclusion Peritoneal CM is an extremely uncommon condition and it is even more rare in the pediatric population, but should be considered in those in the appropriate clinical settings, particularly if they have history to suggest exposure to regions where this fungus is endemic. Disclosures All Authors: No reported disclosures

Chronic pyrrolizidine alkaloid toxicosis in a heifer

This heifer came from a group of cattle with chronic diarrhea and emaciation. Some of the animals also had neurological signs, predominantly aggressiveness. Two animals had already died spontaneously after worsening of the clinical signs. The farmer had kept these animals on native pasture during the winter, and he reported that the vegetation had been scarce in that period. On clinical exam, the animals were in bad body condition, with some presenting dyspnea, subcutaneous edema mainly affecting the dewlap, and abdominal distention.

Caecal duplication, a case report

The caecum is one of the rarest sites of intestinal duplication cysts. The most common symptomatology includes vomiting, abdominal pain, abdominal distention, palpable mass and rectal bleeding. Most of the duplications are diagnosed within the first two years of life, including prenatal diagnosis. Only few cases of caecal duplication have been reported in the literature up to the present day. We are going to present a case of a five-years old girl with caecum duplication who reached our ward due to abdominal distension with no other symptoms.