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  • ISSN: 2373-9312
    Volume 9, Issue 1
    Research Article
    Roman Pawlak*, Ross Grant, Paul Vos, Ayse A. Bilgin, Jade Berg, Robyn Pearce, and Margaret Morris
    Background/Aims: Vegetarians have a high risk of abnormal vitamin B-12 (B-12), and homocysteine (Hcy), status. The objectives included assessment of: 1) folate, B-12, and Hcy status; 2) incidence rate of abnormal folate, B-12, and Hcy; and 3) associations between folate and B-12 with Hcy status among vegetarian and non-vegetarian adolescents.
    Methods: A cross-sectional plasma folate, B-12, and Hcyassessment in 49 vegetarian and 639 non-vegetarian, 14-17 year-old, participants from New South Wales, Australia.
    Results: Mean (range) folate (nmol/L), B-12 (pmol/L), and Hcy (µmol/L), were: 33.4 (9.57-101) vs. 27.7 (2.7-86), p=0.033; 287.81 (134-702) vs. 392.22 (119-1300), p<0.001; and 8.82 (3.1-28.7) vs. 8.19 (2.9-30.8), p=0.33, in vegetarians and non-vegetarians, respectively. A higher percentage of vegetarians were in lower serum B-12 categories, 8.2% vs. 0.9%, for <148pmol/L, p=0.003; 22.4% vs. 9.4%, for B-12 between 148 and 222pmol/L, p<0.001; and 36.7% vs. 22.5%, for B-12 between 222 and 300pmol/L, p<0.001. No statistically significant difference was detected for incidence of abnormal folate or Hcy.
    Conclusions: B-12 is a nutrient of a concern for vegetarian teenagers. To improve B-12 status, vegetarian adolescents should consume foods fortified with B-12, and/or take B-12 supplements.
    Uday Bhaskar and Lakshmi Sundararajan*
    Aim: Thoracoscopy is being used increasingly in Empyema thoracis (ET), in last two decades. We share our single surgeon experience with Video assisted thoracoscopic surgery (VATS), in fibrino-purulent stage (stage 2), of ET in children, especially looking at differences in outcome between necrotizing and non-necrotizing pneumonia.
    Methods: A retrospective case note analysis of stage 2 ET managed by primary VATS and debridement by a single surgeon between 2016 and 2019 was done. Patients were divided according to underlying lung pathology into non-necrotizing (NNP), and necrotizing pneumonia (NP). Outcomes analyzed included success rate, duration of intercostal drainage (ICD), length of hospital stay and complications.
    Results: Out of 25 children studied, 20 had NNP and 5 had NP. Mean age was 3.7 years. In cases of NNP, the mean duration of ICD, post-intervention stay and IV antibiotics was 3.9, 8.7 and 8.5 days respectively. In cases of NP, the same were 9.3, 15 and 13 days respectively. VATS was successful in 95% of cases in NNP while in cases of NP it was 60%.
    Conclusion: Primary VATS and debridement in experienced hands has a high efficacy while reducing the morbidity in empyema with NNP. In children with underlying NP, VATS has with higher failure rate. Accurate identification of NP by radiology or at surgery is important to prognosticate and to plan appropriate treatment.
    Makanda-Charambira PD*, Mujuru HA, Ndhlovu A, Timire C, and Nathoo KJ
    Background: Pneumonia is among the leading causes of mortality in children, accounting for 13% of global under 5 mortality. Studies to determine factors contributing to mortality in childhood pneumonia can help optimize utilization of scarce resources for the most effective preventive and early management strategies in resource limited settings.
    Methods: This hospital based analytical cross-sectional study was conducted between 1 April and 30 July 2017. Hospitalized children aged 1 month to 59 months with WHO defined pneumonia/severe pneumonia were enrolled. They were evaluated to ascertain demographic characteristics, clinical features and laboratory features within 24 hours of admission as related to hospital stay and mortality.
    Results: A total of 309 children were enrolled. The median age was 3 months (IQR 2-10 months) with those aged 2-11 months constituting 61.1% (n=189). Hypoxia was noted in 210 (68.0%) children and clinical features associated with hypoxia on admission were chest wall in drawing (p<0.001), grunting (p <0.001) and lethargy (p <0.001). Median hospital stay was 5 days (IQR: 3-8). The median hospital stay increased significantly with decreasing age (p=0.01) and children with chest X-ray abnormalities on admission were four times more likely to have a prolonged stay in hospital compared to children with normal chest X-rays. Overall mortality rate was 14.2% (n=44) with 36% (n=15) of total deaths occurring within 24hrs of admission. Factors strongly associated with mortality were: severe pneumonia (p=0.001), lethargy (p=0.0001), HIV infection (p=0.0001), hypoxia (p=0.001), central cyanosis (p=<0.001), grunting (p=<0.001), chest wall in drawing (p=0.001) comorbidities (p=<0.0001) and severe malnutrition (p=<0.0001).
    Conclusion: Pneumonia remains a major cause of mortality among hospitalized children in Zimbabwe. Presence of lethargy, hypoxia, HIV infection, comorbidities, severe malnutrition and signs of severe pneumonia such as grunting, cyanosis, head nodding and chest wall in drawing are associated with increased odds of dying.
    Meltem Karabay*, Yahya Yümnu, Didem Altunsoy, Hasan Cetin Ekerbiçer, and Ibrahim Caner
    Objectives: The aim of this study is to investigate the role of ultrasonography (US) and physical examination findings in the diagnosis of NCF in traumatic births.
    Methods: This study was done between July 1st, 2019 and March 31st, 2020. Physical examination, X-ray and US were performed to detect the presence of fracture in traumatic newborns. All newborns were monitored using US by the same radiologist. The obtained data were analyzed statistically by software (SPSS) .
    Results: A total 59/88 (67.0%), fractures were detected and 1/6 (16.7%), of the traumatized newborns delivered by cesarean, whereas 58/82 (70.7%), of the traumatized newborns born via vaginal delivery (p = 0.014). The diagnostic specificity value of US alone was found as 96.6% diagnostic sensitivity of US alone was 79.7%, it increased up to 98.3% in combinations where crepitation exists, yet Moro reflex is absent. A value of 100%, which is the highest specificity, was reached when the US and the presence of crepitation were evaluated together.
    Conclusions: This study demonstrated that NCF is accurately diagnosed using US rather than plain X-ray. In a detailed examination carried out using US, the presence of crepitation, indication of a slight pain and the absence of the Moro reflex are significant to represent the NCF. If suspicious findings are obtained with physical examination, US is sufficient for diagnosis.
    Mini Review
    Bernardino Saccomanni*
    Mesenchymal Hamartoma is a rare, benign osseous tumor that typically involves the rib cage and presents during the first year of life. There is a case of this tumor originating in the cervical spine, described in literature. I document a brief literature review. In this review, there are not figures and outcomes.
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