Cristiana Durdu, Vlad Dima, B. Mihai, I. Ducu, A. Cioca, R. Bohîlțea
The corpus callosum serves as a link between the two hemispheres, with an important role in cognitive mechanisms, also integrating motor and sensitive information and processing stimuli. Evaluation of the morphologic structure of the corpus callosum in order to diagnose structural anomalies such as hyperplasia, hypoplasia, as well as indirect signs of corpus callosum agenesia can be realised using ultrasonography during the mid-trimester screening. At present, it is recommended to perform a targeted evaluation only in high-risk cases of central nervous system abnormalities; the International Society of Ultrasound in Obstetrics and Gynaecology has not included the corpus callosum evaluation in the routine second trimester screening. Callosal anomalies present uncertainty in the fetal prognosis: 75% of cases of isolated corpus callosum agenesis develop normally; on the other hand, they could develop various degrees of neurological impairment from language or social deficiency to autism or schizophrenia. We, therefore, highlight the importance of corpus callosum evaluation, as the agenesis of the corpus callosum can be an isolated defect, but it can also be associated with other extracerebral anomalies or it could be a part of a syndrome. Completing the diagnosis often requires magnetic resonance imaging and genetic tests.
{"title":"The ultrasound evaluation of corpus callosum in the routine screening is not recommended, because we know less than we see","authors":"Cristiana Durdu, Vlad Dima, B. Mihai, I. Ducu, A. Cioca, R. Bohîlțea","doi":"10.37897/rjp.2022.s2.5","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.5","url":null,"abstract":"The corpus callosum serves as a link between the two hemispheres, with an important role in cognitive mechanisms, also integrating motor and sensitive information and processing stimuli. Evaluation of the morphologic structure of the corpus callosum in order to diagnose structural anomalies such as hyperplasia, hypoplasia, as well as indirect signs of corpus callosum agenesia can be realised using ultrasonography during the mid-trimester screening. At present, it is recommended to perform a targeted evaluation only in high-risk cases of central nervous system abnormalities; the International Society of Ultrasound in Obstetrics and Gynaecology has not included the corpus callosum evaluation in the routine second trimester screening. Callosal anomalies present uncertainty in the fetal prognosis: 75% of cases of isolated corpus callosum agenesis develop normally; on the other hand, they could develop various degrees of neurological impairment from language or social deficiency to autism or schizophrenia. We, therefore, highlight the importance of corpus callosum evaluation, as the agenesis of the corpus callosum can be an isolated defect, but it can also be associated with other extracerebral anomalies or it could be a part of a syndrome. Completing the diagnosis often requires magnetic resonance imaging and genetic tests.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45466004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Claudia-Gabriela Potcovaru, T. Salmen, Marius-Costin Chitu, Vlad Dima, Margareta Bianca Mihai, R. Bohîlțea, D. Cinteză
Cerebral Palsy (CP) is a neurodevelopment disorder caused by improper brain development or harm to the developing brain and is the underlying cause of the most common motor disability in children. The clinical symptoms vary between subjects because the etiology is complex and can affect a variety of anatomical structures and each of these can lead to a different symptom. The motor dysfunction is often associated with sensory, perceptual, cognitive, communication and behaviour impairments as well as epilepsy and secondary musculoskeletal disorders which have a significant influence on the child’s quality of life, activity, and participation. The risk of developing CP is present in infants born preterm, but these children sum up less than 50% of cases. The factors that cause CP in children born at term are grouped in antenatal, perinatal, neonatal, some of them can be modified like alcohol consumption, maternal smoking, infections, but others like genetic factor cannot be modified. CP can be classified in different ways depending on the clinical manifestation. Throughout time classification was based on the type and distribution of motor anomalies, which often corresponded to the area of injury. Spastic subtypes, dyskinetic subtypes, and ataxic subtypes are the three basic forms of motor dysfunction. The most common conditions associated with CP are pain, intellectual disability, speech disorder, bladder control problems, epilepsy, and behaviour disorders. Early intervention is thought to be the most effective treatment for CP. As soon as the diagnosis is determined, rehabilitation treatment should begin. The earlier a rehabilitation intervention begins, the better the prospects of improving the child’s functional abilities and independence.
{"title":"Cerebral palsy: review of epidemiology, etiology, clinical features, classification and prevention","authors":"Claudia-Gabriela Potcovaru, T. Salmen, Marius-Costin Chitu, Vlad Dima, Margareta Bianca Mihai, R. Bohîlțea, D. Cinteză","doi":"10.37897/rjp.2022.s2.4","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.4","url":null,"abstract":"Cerebral Palsy (CP) is a neurodevelopment disorder caused by improper brain development or harm to the developing brain and is the underlying cause of the most common motor disability in children. The clinical symptoms vary between subjects because the etiology is complex and can affect a variety of anatomical structures and each of these can lead to a different symptom. The motor dysfunction is often associated with sensory, perceptual, cognitive, communication and behaviour impairments as well as epilepsy and secondary musculoskeletal disorders which have a significant influence on the child’s quality of life, activity, and participation. The risk of developing CP is present in infants born preterm, but these children sum up less than 50% of cases. The factors that cause CP in children born at term are grouped in antenatal, perinatal, neonatal, some of them can be modified like alcohol consumption, maternal smoking, infections, but others like genetic factor cannot be modified. CP can be classified in different ways depending on the clinical manifestation. Throughout time classification was based on the type and distribution of motor anomalies, which often corresponded to the area of injury. Spastic subtypes, dyskinetic subtypes, and ataxic subtypes are the three basic forms of motor dysfunction. The most common conditions associated with CP are pain, intellectual disability, speech disorder, bladder control problems, epilepsy, and behaviour disorders. Early intervention is thought to be the most effective treatment for CP. As soon as the diagnosis is determined, rehabilitation treatment should begin. The earlier a rehabilitation intervention begins, the better the prospects of improving the child’s functional abilities and independence.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70157659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Varlas, Vlad Dima, R. Bors, M. Plotogea, C. Mehedințu
The clinical picture of headaches in pregnancy is a therapeutic challenge through the effects of drugs on the mother and fetus. Headache during pregnancy can be primary or secondary to a severe condition that can endanger the patient’s life (stroke, cerebral venous thrombosis, eclampsia, brain tumors, choriocarcinoma, subarachnoid hemorrhage). Differentiating the type of headache requires a series of investigations: electroencephalography, vascular ultrasound, brain MRI and MRI angiography, and contrast ophthalmoscopy. The evolution without treatment of this pain causes depression, stress, sleep deficit, and malnutrition with disastrous consequences for the mother and fetus. Therapeutic management for the treatment of headaches should be initially non-pharmacological, and low-risk fetal drugs should be used in the absence of a response.
{"title":"Chronic headache and migraine in pregnancy","authors":"V. Varlas, Vlad Dima, R. Bors, M. Plotogea, C. Mehedințu","doi":"10.37897/rjp.2022.s2.9","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.9","url":null,"abstract":"The clinical picture of headaches in pregnancy is a therapeutic challenge through the effects of drugs on the mother and fetus. Headache during pregnancy can be primary or secondary to a severe condition that can endanger the patient’s life (stroke, cerebral venous thrombosis, eclampsia, brain tumors, choriocarcinoma, subarachnoid hemorrhage). Differentiating the type of headache requires a series of investigations: electroencephalography, vascular ultrasound, brain MRI and MRI angiography, and contrast ophthalmoscopy. The evolution without treatment of this pain causes depression, stress, sleep deficit, and malnutrition with disastrous consequences for the mother and fetus. Therapeutic management for the treatment of headaches should be initially non-pharmacological, and low-risk fetal drugs should be used in the absence of a response.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44341480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep disorders in pregnancy are incompletely studied, as they are significant health problems with maternal-fetal implications. These are quite common due to the hormonal, anatomical, and functional changes that occur in the mother’s body. Sleep deprivation influences the mother’s health, with important repercussions on the fetus. Polysomnography shows that the changes regarding sleep architecture begin in the first trimester, and disturbances are also observed after birth. Obstetrical implications (way of birth, duration of labor, analgesia, anesthesia at birth, early onset of labor) and maternal conditions (hypertension induced by pregnancy, gestational diabetes, mental disorders) can change sleep quality. Early identification of sleep disorders, as well as prompt prenatal management, especially through non-pharmacological means, is essential to avoid negative consequences.
{"title":"Changes in maternal sleep during pregnancy and pregnancy outcomes","authors":"R. Bors, Vlad Dima, M. Plotogea, V. Varlas","doi":"10.37897/rjp.2022.s2.20","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.20","url":null,"abstract":"Sleep disorders in pregnancy are incompletely studied, as they are significant health problems with maternal-fetal implications. These are quite common due to the hormonal, anatomical, and functional changes that occur in the mother’s body. Sleep deprivation influences the mother’s health, with important repercussions on the fetus. Polysomnography shows that the changes regarding sleep architecture begin in the first trimester, and disturbances are also observed after birth. Obstetrical implications (way of birth, duration of labor, analgesia, anesthesia at birth, early onset of labor) and maternal conditions (hypertension induced by pregnancy, gestational diabetes, mental disorders) can change sleep quality. Early identification of sleep disorders, as well as prompt prenatal management, especially through non-pharmacological means, is essential to avoid negative consequences.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47263990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eliza Cloțea, R. Bors, Vlad Dima, M. Plotogea, V. Varlas
Premature birth is an important public health problem associated with increased perinatal morbidity and mortality rates. Due to the triggering mechanisms of premature birth as well as the immaturity of the fetal brain, it is more prone to injury. Thus, these premature babies have an increased risk of immediate neurological complications as well as late neurodevelopmental abnormalities, which can have lifelong repercussions. Prompt identification of fetal brain injury and their treatment, as well as the supervision at regular time intervals of the neurodevelopment of children born prematurely, are a real challenge for the medical system.
{"title":"Current therapies to reduce the risk of brain damage associated with preterm birth","authors":"Eliza Cloțea, R. Bors, Vlad Dima, M. Plotogea, V. Varlas","doi":"10.37897/rjp.2022.s2.15","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.15","url":null,"abstract":"Premature birth is an important public health problem associated with increased perinatal morbidity and mortality rates. Due to the triggering mechanisms of premature birth as well as the immaturity of the fetal brain, it is more prone to injury. Thus, these premature babies have an increased risk of immediate neurological complications as well as late neurodevelopmental abnormalities, which can have lifelong repercussions. Prompt identification of fetal brain injury and their treatment, as well as the supervision at regular time intervals of the neurodevelopment of children born prematurely, are a real challenge for the medical system.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46416188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Salmen, Anca Pietrosel, B. Mihai, R. Bohîlțea, D. Mihai, D. Stegaru, Vlad Dima
Objectives. To assess the characteristics of patients with type 2 diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN) as compared to patients with type 2 DM without DPN in an ambulatory setting, given the pandemic size of DM and its challenge for the healthcare systems worldwide in the 21st century. From the chronic complications of DM, DPN has a major impact on the patient’s life quality. DPN risk factors are both modifiable and unmodifiable and represent either other comorbidities per se, or predisposing factors for various comorbidities that alter the patient’s prognosis. Material and Methods. We conducted a retrospective observational study with 112 patients with type 2 DM treated in an out-patient department, in order to assess the characteristics and associated comorbidities of DPN. The group characteristics are a mean age of 60.28±9.76 years; 62.5% males; 77.67% from urban settlement; a prevalence of DPN of 52.67%. Outcomes. In the statistical analysis, DPN significantly associated with duration of DM, the need for insulin-therapy, risk factors such as smoking or obesity; with other complications of DM such as retinopathy, chronic kidney disease, atherosclerotic cardiovascular disease or peripheral artery disease; with comorbidities such as heart failure; and with the level of HDL-cholesterol and eGFR. Conclusions. A patient with DPN is more prone to also present other microvascular complications of type 2 DM, such as chronic kidney disease, retinopathy and, respectively with macrovascular complications of type 2 DM, and with other comorbidities such as heart failure and obesity. Its easily available diagnosis in an ambulatory setting by quantitative sensory testing should offer to DPN the status of a good marker for the presence of other chronic complications or comorbidities in type 2 DM, prompting the patient’s screening and an adequate medical management.
{"title":"Diabetic peripheral neuropathy in the outpatient department – a red-flag for associated risk factors and comorbidities","authors":"T. Salmen, Anca Pietrosel, B. Mihai, R. Bohîlțea, D. Mihai, D. Stegaru, Vlad Dima","doi":"10.37897/rjp.2022.s2.6","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.6","url":null,"abstract":"Objectives. To assess the characteristics of patients with type 2 diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN) as compared to patients with type 2 DM without DPN in an ambulatory setting, given the pandemic size of DM and its challenge for the healthcare systems worldwide in the 21st century. From the chronic complications of DM, DPN has a major impact on the patient’s life quality. DPN risk factors are both modifiable and unmodifiable and represent either other comorbidities per se, or predisposing factors for various comorbidities that alter the patient’s prognosis. Material and Methods. We conducted a retrospective observational study with 112 patients with type 2 DM treated in an out-patient department, in order to assess the characteristics and associated comorbidities of DPN. The group characteristics are a mean age of 60.28±9.76 years; 62.5% males; 77.67% from urban settlement; a prevalence of DPN of 52.67%. Outcomes. In the statistical analysis, DPN significantly associated with duration of DM, the need for insulin-therapy, risk factors such as smoking or obesity; with other complications of DM such as retinopathy, chronic kidney disease, atherosclerotic cardiovascular disease or peripheral artery disease; with comorbidities such as heart failure; and with the level of HDL-cholesterol and eGFR. Conclusions. A patient with DPN is more prone to also present other microvascular complications of type 2 DM, such as chronic kidney disease, retinopathy and, respectively with macrovascular complications of type 2 DM, and with other comorbidities such as heart failure and obesity. Its easily available diagnosis in an ambulatory setting by quantitative sensory testing should offer to DPN the status of a good marker for the presence of other chronic complications or comorbidities in type 2 DM, prompting the patient’s screening and an adequate medical management.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45044377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Salmen, Vlad Dima, Claudia-Gabriela Potcovaru, B. Mihai, D. Cinteză, R. Bohîlțea
Prematurity affects 1 in 10 births and is associated with different degrees of disability and leads to a higher risk of neurological impairment and cerebral palsy (CP). Because its prevalence increase, but with a decrease in mortality rate, there is a burden of survivors that develop sequelae, a problem for the healthcare systems worldwide and for the patient’s social integration. Magnesium sulfate is a useful tool to limit the development of such complications. The risk factors for preterm brain injury act antenatally, intrapartum and postpartum. Even though there are several trials that tried to assess it benefits, magnesium sulfate is on the D list of U.S. Food and Drug Administration for pregnancy and several Societies of Obstetrics and Gynecology tried to implement national guidelines for its safe use. In conclusion it should be used with caution, within 24 hours before birth and under medical surveillance and to administer it only in pregnancies that are at high risk of premature childbirth. If there is a medical emergency involving the mother or the fetus, delivery should not be postponed in order to administer de magnesium sulfate.
{"title":"The neuroprotective effects of magnesium sulfate in utero exposure","authors":"T. Salmen, Vlad Dima, Claudia-Gabriela Potcovaru, B. Mihai, D. Cinteză, R. Bohîlțea","doi":"10.37897/rjp.2022.s2.8","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.8","url":null,"abstract":"Prematurity affects 1 in 10 births and is associated with different degrees of disability and leads to a higher risk of neurological impairment and cerebral palsy (CP). Because its prevalence increase, but with a decrease in mortality rate, there is a burden of survivors that develop sequelae, a problem for the healthcare systems worldwide and for the patient’s social integration. Magnesium sulfate is a useful tool to limit the development of such complications. The risk factors for preterm brain injury act antenatally, intrapartum and postpartum. Even though there are several trials that tried to assess it benefits, magnesium sulfate is on the D list of U.S. Food and Drug Administration for pregnancy and several Societies of Obstetrics and Gynecology tried to implement national guidelines for its safe use. In conclusion it should be used with caution, within 24 hours before birth and under medical surveillance and to administer it only in pregnancies that are at high risk of premature childbirth. If there is a medical emergency involving the mother or the fetus, delivery should not be postponed in order to administer de magnesium sulfate.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48959442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marius-Costin Chitu, Paula-Roxana Raducanu, Vlad Dima, B. Mihai, T. Salmen, Olivia Andrei, Claudia-Gabriela Potcovaru, D. Mischianu, R. Bohîlțea
Introduction. Meningitis is the inflammation of the meninges and can be of infectious cause, the most common being viral, followed by bacterial, but which associates a more severe and rapid evolution, even when it is treated correctly and promptly. In infants and children tuberculous meningitis develops more frequently as a complication of progressive primary infection. Case presentation. A 12-year-old female patient presents to the emergency room with fronto-parietal headache, vomiting, vertigo and lumbar pain, which, despite treatment with oral cephalosporin, returns after 3 days, because the symptoms persist. She is admitted, her treatment is escalated, IV fluoroquinolones and acyclovir are added, along with corticotherapy and cerebral depletives, but within 48 hours the general condition worsens, associating severe headaches, neck stiffness and personality disturbances. Lumbar puncture detects high levels of leukocytes and proteins and low levels of glucose and chlorine, so the patient is transferred to an Intensive Care Unit, intubated and mechanically ventilated. MRI reveals meningoencephalitis with ponto-mesencephalic and cerebellar involvement, with biological minimal leukocytosis with neutrophilia and minimal inflammatory syndrome, the repeated lumbar puncture present the same pathological elements, but the PCR of CSF is positive for Mycobacterium tuberculosis and the diagnosis is of severe tuberculous meningoencephalitis. Under tuberculostatic treatment (isoniazid 5 mg/kg/day, rifampicin 10 mg/kg/day, ethambutol 20 mg/kg/day, pyrazinamide 30 mg/kg/day) associated with vitamin therapy (B1 and B6 – to prevent peripheral neuropathy induced by isoniazid), corticotherapy and cerebral depletives, after 5 days, the evolution was towards healing, which allowed extubation and later discharge, continuing the 7/7 tuberculostatic scheme for 30 days. A subsequent pulmonary assessment is necessary for conversion to 2/7 regime. Conclusions. Meningitis must be promptly and correctly diagnosed and treated, otherwise the evolution is serious, the patient may develop sequelae or even develop towards death. An important element is the anamnesis, because in the presents case, a member of the patient’s family has recently been hospitalized for a respiratory pathology for which he required oxygen therapy.
{"title":"The importance of a correct and prompt diagnostic in a case of bacillar meningo-encephalitis","authors":"Marius-Costin Chitu, Paula-Roxana Raducanu, Vlad Dima, B. Mihai, T. Salmen, Olivia Andrei, Claudia-Gabriela Potcovaru, D. Mischianu, R. Bohîlțea","doi":"10.37897/rjp.2022.s2.11","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.11","url":null,"abstract":"Introduction. Meningitis is the inflammation of the meninges and can be of infectious cause, the most common being viral, followed by bacterial, but which associates a more severe and rapid evolution, even when it is treated correctly and promptly. In infants and children tuberculous meningitis develops more frequently as a complication of progressive primary infection. Case presentation. A 12-year-old female patient presents to the emergency room with fronto-parietal headache, vomiting, vertigo and lumbar pain, which, despite treatment with oral cephalosporin, returns after 3 days, because the symptoms persist. She is admitted, her treatment is escalated, IV fluoroquinolones and acyclovir are added, along with corticotherapy and cerebral depletives, but within 48 hours the general condition worsens, associating severe headaches, neck stiffness and personality disturbances. Lumbar puncture detects high levels of leukocytes and proteins and low levels of glucose and chlorine, so the patient is transferred to an Intensive Care Unit, intubated and mechanically ventilated. MRI reveals meningoencephalitis with ponto-mesencephalic and cerebellar involvement, with biological minimal leukocytosis with neutrophilia and minimal inflammatory syndrome, the repeated lumbar puncture present the same pathological elements, but the PCR of CSF is positive for Mycobacterium tuberculosis and the diagnosis is of severe tuberculous meningoencephalitis. Under tuberculostatic treatment (isoniazid 5 mg/kg/day, rifampicin 10 mg/kg/day, ethambutol 20 mg/kg/day, pyrazinamide 30 mg/kg/day) associated with vitamin therapy (B1 and B6 – to prevent peripheral neuropathy induced by isoniazid), corticotherapy and cerebral depletives, after 5 days, the evolution was towards healing, which allowed extubation and later discharge, continuing the 7/7 tuberculostatic scheme for 30 days. A subsequent pulmonary assessment is necessary for conversion to 2/7 regime. Conclusions. Meningitis must be promptly and correctly diagnosed and treated, otherwise the evolution is serious, the patient may develop sequelae or even develop towards death. An important element is the anamnesis, because in the presents case, a member of the patient’s family has recently been hospitalized for a respiratory pathology for which he required oxygen therapy.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47096028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peripheral nerve injuries in the mother and newborn during delivery represent two obstetrical challenges, for which we try to find the best results both from the point of view of diagnosis and therapeutic strategy. The mother’s lesions can be due to obstetric trauma and neuraxial anesthesia, while fetal injuries are mainly caused by obstetric trauma due to instrumental vaginal delivery but also secondary to abnormal presentations, macrosomia, and deficiencies regarding perinatal monitoring during spontaneous vaginal birth. In most cases, these lesions resolve spontaneously, or if they persist, conservative treatment or surgical correction is necessary. Peripheral nerve injuries in the mother and the newborn continue to remain a challenge addressed to obstetricians and neonatologists, as in-depth, randomized studies are needed to develop clinical guidelines that can be applied.
{"title":"Maternal and neonatal nerves injuries during delivery","authors":"V. Varlas, Vlad Dima, M. Plotogea, R. Bors","doi":"10.37897/rjp.2022.s2.10","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.10","url":null,"abstract":"Peripheral nerve injuries in the mother and newborn during delivery represent two obstetrical challenges, for which we try to find the best results both from the point of view of diagnosis and therapeutic strategy. The mother’s lesions can be due to obstetric trauma and neuraxial anesthesia, while fetal injuries are mainly caused by obstetric trauma due to instrumental vaginal delivery but also secondary to abnormal presentations, macrosomia, and deficiencies regarding perinatal monitoring during spontaneous vaginal birth. In most cases, these lesions resolve spontaneously, or if they persist, conservative treatment or surgical correction is necessary. Peripheral nerve injuries in the mother and the newborn continue to remain a challenge addressed to obstetricians and neonatologists, as in-depth, randomized studies are needed to develop clinical guidelines that can be applied.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41503341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andreea Calomfirescu-Avramescu, A. Stancu, Vlad Dima, R. Bohîlțea, V. Varlas, A. Toma, A. Davitoiu
Background. The incidence of multiple pregnancies is increasing in the last 10 years, along with the associated complications. Brain injuries and neurological complications associated with single fetal intrauterine death (sIUFD) are the most serious and have a negative impact on the surviving twin. Methods. This review was performed by a single individual who searched via Google Scholar and Pubmed clinical studies which included sIUFD in monochorionic (MC) twin pregnancies. This research included studies from the last 10 years and the keywords used were: “single intrauterine fetal death”, “monochorionic”, “fetal brain lesions”, and “twin pregnancies”. Results. After analyzing the clinical studies according to the keywords, only 15 studies (462 pregnancies) met the inclusion criteria. These included: monochorionic pregnancies and sIUF that occurred after 14 weeks. The results of these trials showed a strong statistical association between single fetal intrauterine death and co-twin fetal brain lesions and neonatal death. Also, many of these recent studies mentioned the relationship between monochorionic city and preterm delivery, fetal growth restriction and twin–twin transfusion syndrome (TTTS). Conclusion. Analyzing all these clinical studies, we can conclude that the intrauterine death of a twin in monochorionic pregnancies after the age of 14 weeks of gestation significantly affects the neurological development of the surviving twin.
{"title":"Fetal brain injury in survivors of twin pregnancies in single fetal intrauterine death – a short literature review","authors":"Andreea Calomfirescu-Avramescu, A. Stancu, Vlad Dima, R. Bohîlțea, V. Varlas, A. Toma, A. Davitoiu","doi":"10.37897/rjp.2022.s2.16","DOIUrl":"https://doi.org/10.37897/rjp.2022.s2.16","url":null,"abstract":"Background. The incidence of multiple pregnancies is increasing in the last 10 years, along with the associated complications. Brain injuries and neurological complications associated with single fetal intrauterine death (sIUFD) are the most serious and have a negative impact on the surviving twin. Methods. This review was performed by a single individual who searched via Google Scholar and Pubmed clinical studies which included sIUFD in monochorionic (MC) twin pregnancies. This research included studies from the last 10 years and the keywords used were: “single intrauterine fetal death”, “monochorionic”, “fetal brain lesions”, and “twin pregnancies”. Results. After analyzing the clinical studies according to the keywords, only 15 studies (462 pregnancies) met the inclusion criteria. These included: monochorionic pregnancies and sIUF that occurred after 14 weeks. The results of these trials showed a strong statistical association between single fetal intrauterine death and co-twin fetal brain lesions and neonatal death. Also, many of these recent studies mentioned the relationship between monochorionic city and preterm delivery, fetal growth restriction and twin–twin transfusion syndrome (TTTS). Conclusion. Analyzing all these clinical studies, we can conclude that the intrauterine death of a twin in monochorionic pregnancies after the age of 14 weeks of gestation significantly affects the neurological development of the surviving twin.","PeriodicalId":33512,"journal":{"name":"Revista Romana de Pediatrie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43101076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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