DOI: 10.5005/jp-journals-11002-0048 |
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Srivastava A, Kaur S, Kamaluddeen M, Murthy P, Stritzke A, Al Awad E, Thomas S, Mohammad K, Soraisham A. Efficacy of Pharmacologic Therapy for Patent Ductus Arteriosus Closure in Preterm Small for Gestational Age Infants. 2022; 1 (4):327-332.
Objective: To determine the association between the degree of intrauterine growth restriction (IUGR) [defined by birth weight (BW) Z-score] and the efficacy of pharmacologic patent ductus arteriosus (PDA) closure and the rate of surgical PDA ligation in preterm neonates.
Materials and methods: In this retrospective cohort study, we included neonates born below 30 weeks’ gestational age (GA), who received medical treatment for PDA between January 2010 and December 2018. Birth weight Z-scores were calculated using Olsen nomograms and classified into three categories: above −0.5; from −0.5 to −2.0; below−2. We compared responses to PDA treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and PDA ligations between these groups utilizing multivariable logistic regression analysis.
Results: Of 769 neonates with PDA, 517 (67.2%) neonates received medical treatment for PDA. Of which, 323 (62.5%) had BW Z-score above −0.5, 154 (29.8%) had from −0.5 to −2.0., and 40 (7.7%) had below −2. The efficacy of the first course of NSAIDs for the PDA closure was not different among the three groups (51% vs 49% vs 50%). Multivariable logistic regression analysis showed there was no significant difference in PDA closure rate following the first course of NSAIDs between neonates with BW Z-score below −2 and those with BW Z-score above −0.5 [adjusted odds ratio (aOR): 0.68; 95% CI: 0.33–1.39] as well as those with BW Z-score from −0.5 to −2.0 (aOR: 0.89; 95% CI: 0.59–1.35). However, the odds of PDA ligation were significantly higher among neonates with BW Z-scores below −2 (aOR: 2.67, 95% CI: 1.12–6.34) but not among neonates with Z-scores from −0.5 to −2.0 (aOR: 1.41; 95% CI: 0.84–2.39), as compared to those with BW Z-scores above –0.5.
Conclusion: We observed a similar rate of PDA closure following the first course of NSAIDs between appropriately grown and growth-restricted neonates. However, severe growth restriction (BW Z-score below −2) is associated with higher rates of PDA ligation as compared to normally grown infants.
Healthcare systems widely use information technology (IT) for system authentication (digital signatures), web surfing, e-mails, instant messaging, protecting data at rest, Voice over Internet Protocol (VoIP) telephony, and cellular telephony. To protect patient identification and healthcare information, cryptographic systems are widely used to secure these data from malicious third parties (adversaries). In our healthcare systems, we have had reasonable success in the efficient storage of the information of our patients and their families, in its timely retrieval, and in ensuring its safety from adversaries. However, the data are increasing rapidly and our current computational systems could be inadequate in the not-so-distant future. In this context, there is a need for novel solutions. One possibility can be seen in quantum computing (QC) algorithms/devices that can provide elegant solutions based on subatomic interactions. In this review, we have summarized current information on the need, current options, and future possibilities for the use of QC algorithms/devices in large data systems such as healthcare. This article combines peer-reviewed evidence from our own clinical studies with the results of an extensive literature search in the databases PubMed, EMBASE, and Scopus.
Macrophages are large highly motile phagocytic leukocytes that appear early during embryonic development and have been conserved during evolution. The developmental roles of macrophages were first described nearly a century ago, at about the time these cells were being identified as central effectors in phagocytosis and elimination of microbes. Since then, we have made considerable progress in understanding the development of various subsets of macrophages and the diverse roles these cells play in both physiology and disease. This article reviews the phylogeny and the ontogeny of macrophages with a particular focus on the gastrointestinal tract, and the role of these mucosal macrophages in immune surveillance, innate immunity, homeostasis, tissue remodeling, angiogenesis, and repair of damaged tissues. We also discuss the importance of these macrophages in the inflammatory changes in neonatal necrotizing enterocolitis (NEC). This article presents a combination of our own peer-reviewed clinical and preclinical studies, with an extensive review of the literature using the databases PubMed, EMBASE, and Scopus.
Background: Neonatal hyperbilirubinemia is a common clinical condition worldwide. Phototherapy (PT) is the standard intervention for hyperbilirubinemia; however, it may have side effects. It has been suggested that the implementation of adjuvant therapy including ursodeoxycholic acid (UDCA), for example, may decrease the duration of PT.
Objectives: To determine the efficacy and safety of UDCA in addition to PT in term neonates with unconjugated hyperbilirubinemia (UH) vs PT alone.
Methods: A systemic review was undertaken using the following databases: PubMed, Medline, Cochrane database, Scopus, Google Scholar, and ClinicalTrials.gov. Randomized controlled trials (RCTs) assessing the efficacy and safety of UDCA combined with PT on the total serum bilirubin (TSB) and duration of PT were included. The data quality assessment was carried out.
Results: Low–moderate quality evidence from seven RCTs reported significantly lower TSB levels in the UDCA group compared to the control group after 12, 24, 48, and 72 hours of treatment with a mean difference (MD) of –2.23 mg/dL (95% CI: from −2.49 to −1.96); −1.59 mg/dL (95% CI: from −1.83 to −1.35); −1.03 mg/dL (95% CI: from −1.27 to −0.79); and −1.32 mg/dL (95% CI: from −1.63 to −1.01), respectively, with heterogeneity of studies I2 = 92% (p < 0.00001). In addition, three studies observed that UDCA significantly decreased the duration of PT with MD −19.14 hours (95% CI: from −20.70 to −17.59) with heterogeneity I2 = 91% (p < 0.00001). None of the studies reported any significant adverse effects of UDCA.
Conclusion: Ursodeoxycholic acid combined with PT in the treatment of UH significantly reduces the TSB and duration of PT without significant risk of adverse events. However, limited and low–moderate quality evidence exists to support the routine use of UDCA in neonates. We discuss the limitations of the review results for clinical practice.
Hepatitis B infections are estimated to affect more than 2 billion people worldwide. The overall prevalence of HBsAg positivity in plasma is reported to be 3.5%, but it varies depending on the geographic area. Mother-to-child infection is the predominant mode of transmission in high-prevalence areas. In exposed infants, universal hepatitis B vaccination and the administration of hepatitis B immunoglobulin (HBIg) within 12 hours following the birth can reduce the risk of perinatal infection. The rates of progression to chronic hepatitis B infection depend on the age of infection and are the highest in perinatally acquired infections, thus underscoring the importance of measures to reduce transmission. Timely identification and treatment of the affected pregnant women and immunoprophylaxis of newborn infants are of paramount importance to reduce the burden of chronic infection.
Human milk banks (HMBs) collect, screen, process, and dispense donated human milk (HM). There are more than 500 large HMBs in the world but only a few are functioning in Muslim countries, and that too on a limited scale. Human milk banks that are similar to those in the Western countries have been difficult to establish in Muslim countries as Islamic laws do not allow the consumption of unidentified donated milk from multiple donors. Human milk is known to be important for nutrition in premature and critically ill infants, and so there is a well-recognized need to develop religiously compliant and conditionally identified HMBs in Muslim countries. In these milk banks, every mother's milk is processed and stored separately, and the milk provided by one mother can be provided to an infant from a different family only after appropriately counseling both families about the Islamic laws of prohibition of future marriages between milk siblings. Documents related to these issues are provided to both families and data need to be maintained for future reference. In this article, we recount the educational, financial, and infrastructural challenges that we faced in establishing religiously-compliant HMB in Bangladesh. There is already a noticeable reduction in infant mortality in our region.
Human milk (HM) feedings are important for all newborn infants. Healthy term infants grow well with the mother's own milk (MOM), be it in direct breastfeeding or when fed expressed breastmilk. Premature and ill infants being treated/monitored in neonatal intensive care units (NICUs) also recover better when fed with HM diets, which can include MOM, donor milk (DM), or a combination of both. In terms of chemical composition, it contains 3–5% fat, 0.8–0.9% protein, 6.9–7.2% carbohydrates (calculated as lactose), and 0.2% mineral constituents. In this review, we present the latest information on HM fats, including triglycerides, phospholipids, triglycerides, cholesterol, glycoproteins, and enzymes. This article is intended to initiate a series of periodic updates on the scientific information available on HM fats. It contains some of our own research findings with an extensive review of the literature. To avoid bias in the identification of studies, keywords were short-listed a priori from anecdotal experience and from PubMed's Medical Subject Heading (MeSH) thesaurus. We then searched the databases PubMed, EMBASE, and Science Direct.
DOI: 10.5005/jp-journals-11002-0051 |
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Padhi BK, Manna S, Pallepogula DR, Kumar J, Joshi B, Sah R, Aggarwal AK. Prevalence of Gram-negative Bacteria in Maternal Cervical Secretions: A Systematic Review and Meta-analysis. 2022; 1 (4):397-407.
Background: In neonates, early-onset sepsis (EOS) occurring within 72 hours after birth is an important cause of mortality worldwide. Emerging data show that EOS may occur more frequently in tropical and peri-equatorial regions with more gram-negative bacteria than in the Western countries. This systematic review aimed to estimate the prevalence of gram-negative bacteria in the maternal genital tract during the peripartum period.
Materials and methods: We explored the primary research studies that reported the presence of gram-negative bacteria in the maternal genital tract using the software STATA, version 17.1. Five databases, PubMed, Embase, Scopus, Web of Science, and ProQuest were searched until October 2022. Data were analyzed using random-effects meta-analyses to determine the prevalence of gram-negative bacteria in the maternal genital tract.
Results: Fifteen studies qualified for analysis by our predetermined inclusion criteria. The overall prevalence of gram-negative bacteria in cervical secretions was 23.20% (95% CI [confidence interval]: 11.77–37.08, I2: 99.79%). Escherichia coli (15.3%) and Acinetobacter (0.36%) species reported the highest and lowest prevalent bacteria, respectively. The prevalence of other gram-negative species was Klebsiella pneumoniae (0.47%), Pseudomonas (2.81%), Enterobacter (3.33%), Alcaligenes faecalis (1.32%), Proteus vulgaris (10.0%), and Providencia alcalifaciens (10%). Most of the studies were from tropical countries, and there was a positive linear relationship between the studies.
Conclusion: Gram-negative colonization of the maternal cervical-vaginal tract may be more frequent than previously recognized in tropical/peri-equatorial regions of the world. Early identification of these bacterial pathogens may help in timely evaluation and treatment of these infants.