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HUMAN CYTOMEGALOVIRUS INFECTION AMONG NEONATES WITH SYMPTOMATIC CONGENITAL INFECTIONS AND BIRTH DEFECTS

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Abstract

Background:Human cytomegalovirus (HCMV) is the major viral etiology of congenital infection and birth defects, during current maternal infection the fetal transmission is high (30-40%) and the symptomatic neonates have diseases involving the neurologic, hematopoietic, respiratory and other organ systems, causing high mortality and long-term sequelae.Objective:To measure the frequency of congenital and perinatal HCMV infection among symptomatic neonates and its possible burden of disease among them.Methods:A total of one hundred ninety-eight symptomatic neonates with clinical manifestations of overt congenital infection enrolled in this study from September 2014 to March 2015. Serum samples were obtained from each subject targeted in this study. HCMV infection was defined as HCMV-IgM antibody positive by Electrochemiluminescence Immunoassay (ECLIA) techniques. Results:The prevalence of HCMV infection among symptomatic neonates with congenital infection was 25 (12.6%). The average age of HCMV detection was 9.96 (SD 6.73) days with a median of 7 days, a minimum of 3 days and a maximum of 28 days. Jaundice was the most predominant clinical finding 14 (56%), followed in order of frequency by hepatomegaly 9 (36%) and pneumonitis 7 (28%).Conclusion:The high prevalence of neonatal HCMV infection among neonates with symptomatic congenital infections could indicate a high rate of maternal HCMV primary or current infection among our population.Keywords: HCMV, congenital infection, neonates, clinical finding.


Article
Review of 31 cases of neonatal gastrointestinal perforations
الامعاء في الاطفال حديثي الولادة فيما يخص المميزات الديموغرافية والتشخيص السريري

Author: Haithem H. Ali Almoamin م. د هيثم حسين علي المؤمن
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2016 Volume: 58 Issue: 2 Pages: 121-125
Publisher: Baghdad University جامعة بغداد

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Abstract

Abstract:Background: Despite the recently improved neonatal intensive management, gastrointestinal perforation during the neonatal period is still a major challenge for pediatric surgeons.Objective: To review the effects of different clinical and operative parameters on the mortality of neonatal intestinal perforations. Patients and Methods: A retrospective study was done to 31 cases of neonatal intestinal perforation at the neonatal intensive care unit of Basrah children speciality hospital during the past four and half years (July 2011 to December 2015). Information regarding the age, sex, gestational age, birth weight, clinical examination, x-rays value in diagnosis, causes and sites of perforations, types of operative procedures, and their effects on prognosis are all studied.Results: Males were affected more than females (a ratio of 3.4: 1); birth weight has a significant association with the prognosis (P-value of 0.045). Hirschsprung`s disease was the commonest cause for perforation (29%), followed by necrotizing enterocolitis and jejunoileal atresia (16.1%, each). Idiopathic perforations constituted only 12.9%. Ileum was the commonest site of perforation (58.1%), followed by cecum (16.1%). Stoma creation was the commonest operative procedure performed. Other procedures like, primary anastomosis, and primary peritoneal drainage followed by laparotomy were also used. This study revealed high mortality rate (45.2%). Complications like sepsis, anastomotic leaks, or burst abdomen carried a high risk of death.Conclusions: High mortality rate is encountered, especially for necrotizing enterocolitis. In contrast to other study, Hirschsprung`s disease is the commonest cause of perforation rather than necrotizing enterocolitis. Radiology has a relatively good accuracy in the diagnosis of intestinal perforations, although some cases were discovered intra-operatively. In this series, prompt accurate treatment with stoma creation harbored the best prognostic results; furthermore no benefits obtained from primary peritoneal drainage.Keywords: neonates, perforations, intestine, mortality.

الخلاصةالخلفية: على الرغم من التقدم الحاصل في معالجة انثقاب الامعاء في الاطفال حديثي الولادة, لا يزال انثقاب الجهاز الهضمي يمثل تحديا رئيسيا لجراحي الاطفال.الهدف: يهدف البحث الى استعراض ثقوب الامعاء في الاطفال حديثي الولادة فيما يخص معدل الوفيات ودراسة المؤثرات السريرية المختلفة وتاثير طرق التداخلات الجراحية على معدل الوفيات. المرضى والطرق: تمت دراسة 31 حالة انفجار الامعاء في مستشفى البصرة التخصصي للاطفال- وحدة العناية المركزة للفترة من (تموز 2011- كانون الاول 2015). تناول البحث دراسة العمر, الجنس, العمر الحملي, الوزن عند الولادة, الفحص السريري, الاشعة السينية, اسباب واماكن الثقوب, والعمليات الجراحية. وتمت دراسة تاثيرات تلك العوامل على معدل الوفيات. النتائج: بينت الدراسة تاثر الذكور اكثر من الاناث. الوزن عند الولادة لة ارتباط كبير مع الوفاة. مرض شلل القولون الولادي هو السبب الاكثر شيوعا يليه التهاب الامعاء التفسخي وضمور الامعاء الدقيقة.اللفائفي يليه الاعور كانت اكثر الاماكن المتاثرة. تفويم الامعاء هو الاجراء الاكثر استخداما. الاستنتاجات: كشفت الدراسة ارتفاع نسبة الوفيات وخاصة بالنسبة لالتهاب الامعاء التفسخي. شلل القولون الولادي هو السبب الرئيسي لانثقاب الامعاء بدلا من التهاب الامعاء التفسخي. قلة حالات التهاب الامعاء التفسخي يعود الى ارتفاع نسبة الوفيات في الولادات ذات الاوزان القليلة جدا في مجتمعنا حيث تكثر الاصابة بالتهاب الامعاء التفسخي. لم يكشف البحث اي فائدة تذكر من استخدام التصريف البريتوني الاولي كعلاج اولي لانثقاب الامعاء.الكلمات الرئيسية: حديثي الولادة, الامعاء, انثقاب, الوفيات

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