20th Week Research Articles

Defective thyroid hormone transport to the brain leads to astroglial alterations

Allan-Herndon-Dudley syndrome (AHDS) is a rare X-linked disorder that causes severe neurological damage, for which there is no effective treatment. AHDS is due to inactivating mutations in the thyroid hormone transporter MCT8 that impair the entry of thyroid hormones into the brain, resulting in cerebral hypothyroidism. However, the pathophysiology of AHDS is still not fully understood and this is essential to develop therapeutic strategies. Based on evidence suggesting that thyroid hormone deficit leads to alterations in astroglial cells, including gliosis, in this work, we have evaluated astroglial impairments in MCT8 deficiency by means of magnetic resonance imaging, histological, ultrastructural, and immunohistochemical techniques, and by mining available RNA sequencing outputs. Apparent diffusion coefficient (ADC) imaging values obtained from magnetic resonance imaging showed changes indicative of alterations in brain cytoarchitecture in MCT8-deficient patients (n = 11) compared to control subjects (n = 11). Astroglial alterations were confirmed by immunohistochemistry against astroglial markers in autopsy brain samples of an 11-year-old and a 30th gestational week MCT8-deficient subjects in comparison to brain samples from control subjects at similar ages. These findings were validated and further explored in a mouse model of AHDS. Our findings confirm changes in all the astroglial populations of the cerebral cortex in MCT8 deficiency that impact astrocytic metabolic and mitochondrial cellular respiration functions. These impairments arise early in brain development and persist at adult stages, revealing an abnormal distribution, density, morphology of cortical astrocytes, along with altered transcriptome, compatible with an astrogliosis-like phenotype at adult stages. We conclude that astrocytes are potential novel therapeutic targets in AHDS, and we propose ADC imaging as a tool to monitor the progression of neurological impairments and potential effects of treatments in MCT8 deficiency.

A Time and Cost Analysis to Pier Construction Project in Tuban by Earned Value Analysis Method

The development of a project must be attentive to certain aspects of cost, quality and the implementation time. Planning and control need to be carried out to increase the likelihood of success in a project. The condition of the pier construction project in Tuban as the research object in this study is experiencing delay, so this research is intended to provide the cost and time analysis results as approached with a method of Earned Value Analysis (EVA). A project status can be identified early and in more accurate way with EVA, so this method can be used as a basis for improving the project condition by calculating three indicators; Planned Value (PV), Earned Value (EV) and Actual Cost (AC). These indicators were used in the analysis of this research. The research procedure was carried out by collecting, summarizing and analyzing data. The required data is the cost budget plan, time schedule, weekly project progress report and weekly actual costs, and by processing these data, the planning value (PV), result value (EV), and actual value (AC) will be produced. Result of the research analysis were in the form of Cost Performance Index or CPI value where until the 29th week revealing a value below 1 (<1) meaning there was a cost overrun in this project, and the CPI value for the 30th week to 49th week is above 1 (>1) meaning there is a cost underrun in this project which in the 49th week has CPI value of 1.11. Meanwhile, for the time performance index or SPI, until the 19th week has a value of above 1 (>1) meaning there is an acceleration progress in this project, while at the 20th to 49th weeks the SPI value is below 1 (<1) meaning the project is experiencing a delay, with a SPI value for the 49th week is 0.81. With a total contract of Rp. 10,403,914,724 and the CPI value of 1.11, it is expected that the project is able to put into completion with a remaining cost of only Rp.2, 047, 216, 930. This study was conducted in the 49th week of the 54 weeks project plan schedule, and by assumption of no changes in project performance (or the project performance remain the same until project completion), it is expected that the project will be completed within 62 weeks, meaning it requires an additional 8 weeks of time from the initial contract.

Pregnancy after advanced ovarian cancer with spontaneous uterine rupture in second trimester: A case report and review of the literature.

Fertility-preserving surgery (FPS) in advanced ovarian cancer (AOC) is extremely rare and consequently, information about the pregnancies of these patients is anecdotal. Therefore, management of the pregnancy after AOC is challenging, especially if an unexpected situation arises. A 31-year-old nulliparous woman was admitted to our tertiary hospital in the 18th week of twin pregnancy with sudden severe abdominal pain. Her medical history included a low-grade AOC stage IIIc diagnosed 2 years before pregnancy and treated by debulking FPS and systemic therapy with carboplatin/paclitaxel and bevacizumab. Clinical examination described normal vital signs and peritoneal irritation without any vaginal discharge. Sonography revealed free fluid in the pouch of Douglas and intact twin pregnancy. Laboratory work showed elevated leukocytes with neutrophilia. To evaluate appendicitis magnetic resonance imaging of the abdomen was indicated. This revealed a uterine rupture with the now extra-cavitary position of the twins. Simultaneously, the patient's symptoms deteriorated, and emergency surgery was necessary where hemoperitoneum with avital fetuses were present. Despite excessive blood loss the uterus could be repaired and preserved. Previous resection of the uterine serosa during her debulking FPS, administration of bevacizumab affecting smooth muscles, and overstretching the uterus in the twin pregnancy were considered as possible risk factors for the presenting uterine rupture. Pregnancy after AOC is possible but should be monitored closely, especially due to the hidden long-term consequences of its therapy. In the differential diagnosis of sudden abdominal pain during pregnancy uterine rupture should be considered even in patients with an unscared uterus.

Biomarkers of placental dysfunction. Clinical experience

The objective: to determine the diagnostic value of biomarkers of placental dysfunction at different stages of gestation.Materials and methods. The research was carried out in 2015–2022 on the basis of the municipal non-commercial enterprise “Maternity House No.5” of the Odesa City Council.We analyzed the course and clinical outcomes of pregnancies in 118 women (the main group) who developed and established placental dysfunction (PD) during pregnancy at different stages of gestation. The control group included 78 healthy women whose pregnancies occurred without PD.In women of both groups the frequency of detection of risk factors for PD was assessed by analyzing the content of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) biomarkers in blood serum, Pregnancy-Associated Plasma Protein A (PAPP-A) and β-subunit of chorionic gonadotropin (hCG).Fetal growth retardation was determined by deviations of fetal metric indicators (abdominal circumference, head circumference, biparietal size, thigh length, estimated fetal weight) below the 10th percentile.Statistical processing of the obtained results was carried out using Statistica 14.0 software (TIBCO, USA).Results. Among the examined women of both groups, cases where the pregnancy occurred at the age of 30 years or more and was the first pregnancy that did not end in abortion prevailed. The average age of women in the main group was 33.4±2.3 years, the control group – 29.3±1.4 years.The main group had more women with a history of multiple abortions (odds ratio (OR)=5.6, 95% confidence interval (CI): 1.9–18.8). Disorders of the menstrual cycle in history were found in 39 (33.1%) women of the main group and in 18 (23%) women of the control group (OR=1.6, 95% CI: 0.9–3.2). Concomitant gynecological diseases were represented by uterine fibroids – in 16 (13.6%) pregnant women of the main group and in 8 (10.2%) women of the control group (OR=1.4, 95% CI: 0.6–3.4), benign ovarian tumors – in 13 (11.0%); OR=20.1, 95% CI: 1.2–343.1), mastopathy – in 19 (16.1%; OR=30.8, 95% CI: 1.8–517.6) women of the main group.A significant number of women in the main group had a hypertrophic nutritional status – the body mass index (BMI) at the time of pregnancy was on average 26.7±0.9 kg/m2, women in the control group were represented by the normotrophic type (BMI – 22.2±0.3 kg/m2), in 4 women the indicator was more 30 kg/m2.In the vast majority of pregnant women (68 persons – 57.6%) of the main group the signs of placental malperfusion were registered up to 34 weeks. In 12 (10.2%) cases a primary PD was established.The content of PIGF in women of the main group at the 20th week of pregnancy decreased to 83±4 pg/ml, which is significantly less than the reference values (≥100 pg/ml). On the other hand, in the control group the PIGF concentration was 147±8 pg/ml (p<0.05). The sFlt-1 amount in the main group corresponded to the level of 3395±62 pg/ml. Therefore, the ratio of sFlt-1/PlGF was equal to 40.8±0.4, which is prognostically unfavorable.The PAPP-A indicator, according to monitoring data at the 20th week of pregnancy, was 0.77±0.08 mU/l. In pregnant women with lower values in the future PD occurred earlier. As for the indicators of the β-subunit of hCG, the levels of this hormone in most cases corresponded to the normative values, amounting to an average of 4.7±0.1 IU/l in a pregnancy with a male fetus and 8133±21 IU/l in a pregnancy with a female fetus.Signs of preeclampsia were determined in 22 (18.6%) pregnant women of the main group. The value of the sFlt-1/PlGF ratio in these pregnant women exceeded 50.0.Conclusions. In the vast majority of pregnant women of the main group (68 – 57.6%) the signs of placental malperfusion were found up to 34 weeks. In 22 (18.6%) pregnant women with placental dysfunction (PD) the signs of preeclampsia were detected, the development of which increases when the sFlt-1/PlGF ratio exceeds 50, starting from the II trimester of pregnancy, which is an early biomarker of PD.

The prevalence of inflammatory process in placentas from premature births in different gestational periods

Premature birth (PB) is the birth in less than 37 weeks, which can be spontaneous and iatrogenic, its frequency reaches 10% of all births. The pathogenesis of premature labor is based on the inflammatory reaction of the chorion, amnion and decidual membrane, but the origin of the inflammatory reaction is different depending on the gestational age.The objective: to study the prevalence of the inflammatory response in placenta samples from very early preterm, early preterm and term births.Materials and methods. Placenta samples from 203 parturient women who gave birth in the gestational period of 22–27 weeks – very early PB (I group – 101 parturient women with premature rupture of membranes (PROM), II group – 102 parturient women with the onset of labor with intact membranes) and 202 parturient women were examined with deliveries in the period of 28–34 weeks – early PB (III group – 100 women in labor with PROM and IV group – 102 women in labor with the onset of labor with intact fetal membranes) and 60 women in labor with term deliveries.Immunohistochemical detection of CD8, CD3 and CD14 antigens in villi was used to assess the prevalence of the inflammatory process and compare it between groups.Results. In 56.7% of placentas from term deliveries no markers of villousitis were detected, a mild form of villousitis was found in another third of cases. In placentas of woman with the onset of labor between the 28th and 34th weeks with intact fetal membranes there were signs of villousitis in 54.9%, and its mild manifestations in 33.3%. In the case of premature rupture of the membranes, the prevalence of villousitis reached 65%, its severe forms were more often observed.On the other hand, in the groups of very early PB only 14.9 and 15.7% of placentas had no signs of vilouisitis, one in five placentas from these groups had severe focal or diffuse villousitis. In the group of early PB and intact amniotic membranes, one third of the placentas demonstrated an isolated CD3 lymphocyte marker, no antigen was detected in 47.1% of placentas, and only in every tenth placenta antigens of macrophages of fetal origin were determined. A similar distribution was found in placentas from early PB with PROM.In placentas from very early PB the highest frequency of CD14 detection was found – every second placenta contained this marker in isolation and in 22.5% – in combination with maternal lymphocyte markers. In the group of very early PB on the background of PROM placentas with a positive CD14 test dominated – 31.7% isolated and 45.5% in combination with CD3.Conclusions. 1. In placentas from premature births (PB) at 28–34 weeks, villousitis was detected in 54.9% of cases against the background of intact amniotic membranes and in 65.0% – on the background of premature rupture of the membranes, from very early PBs – in 85.1% and 83.3%, respectively. Placentas from deliveries with premature rupture of the fetal membranes more often had signs of severe villousitis – in 21% of cases at 28–34 weeks and in 20.6% at 22–27 weeks.2. In placentas from early PB, macrophage antigen of fetal origin was detected in 22% of cases in the cases of premature rupture of the fetal membranes and in 21.6% of cases of childbirth with intact membranes; these samples were dominated by infiltration by lymphocytes of maternal origin. On the other hand, placentas from very early PB and ruptured fetal membranes in 77.2% of cases contained antigen of fetal macrophages and in 71.6% of cases of onset of labor with intact membranes.Such results indicate the fetal origin of the inflammatory process in very early PB.

Effect of Genetic Groups and Gender on Body Weight and Different Morphometric Traits in Poultry Birds

Background: Traits of economically importance are quantitative, complex with continuous variability in chickens whereas body morphometric parameters are variable on the basis of some factors such as age, sex, nutrition, climate and status of the birds which is very important in differentiating native from exotic as well as commercial breeds. Methods: Three genetic groups of chicken i.e., Rhode Island Red (RIR), Kadaknath and Punjab Brown were classified according to gender and genetic groups. The body weight was measured from 0 day to 26th week of age and morphometric trait from 12 to 26th week of age. The fixed effect of gender and genetic groups on different fortnightly body weights (BW) and morphometric traits were estimated. Result: Punjab Brown poultry birds had significantly higher (p≤0.01) body weight and morphometric traits viz. beak length (BKL), keel length (KL), wing length (WL) and body girth (BG) for most of the studied weeks. Male birds consistently had significantly (p≤0.01) higher body weight and important morphometric parameters viz. shank length (SL), shank width (SW), BKL, comb length (CL), KL and WL compared to females across all age groups which interprets the significance of different non-genetic factors on body weight and important morphometric parameters for further selection in different breeds of poultry birds.

How do maternal socioeconomic and behavioral patterns affect oral health in early childhood?

A prospective longitudinal observational cohort study. The data analyzed were derived from a comprehensive observational study on BRISA prenatal cohort conducted in São Luís City, Brazil, between 2010 and 2013. A convenience sample included pregnant women recruited from both public and private prenatal health services in the city. To participate in the study, women needed to have undergone an obstetric ultrasound before the 20th week of pregnancy to estimate gestational age. Multiple pregnancies were excluded. Initially, the pregnant women were interviewed and assessed for oral health indicators between the 22nd and 25th weeks of pregnancy. A follow-up interview was conducted within 48 h after delivery. In the child's second year, the mothers were re-interviewed, and the children were examined for the second follow-up. The study received approval from the local ethics committee, and written informed consent was obtained from all participants. The research followed the STROBE guidelines for reporting observational studies. At baseline, a structured questionnaire was used to gather sociodemographic and lifestyle information like maternal age, family income, education level, occupation of the family head, pre-gestational BMI, alcohol and soft drink consumption, and smoking status during pregnancy. Dental examinations were conducted by 6 trained and calibrated dentists who assessed DMFT index and periodontal health indicators. In the second follow-up, children's oral health was evaluated using visible plaque index (VPI), gingival bleeding, and the modified dmft index. Children's weight and height were measured by a digital scale, and BMI z-scores were calculated based on WHO standards. Sugar-sweetened beverage intake was categorized by terciles based on the percentage of total daily energy from these beverages. Structural equation modeling (SEM) was used to analyze multiple pathways among a set of latent and observed variables. Three latent variables were proposed and measured: Socioeconomic Status and Periodontal Maternal Status in the mothers, and Chronic Oral Disease Burden (CODB) in the children. CODB was inferred from 3 observed indicators: VPI, gingival bleeding, and tooth decay. Total, direct, and indirect effects were calculated for variables from the gestational period and the child's second year of life. In total, 1141 mother-child dyads were included. Periodontal Maternal Status correlated with more decayed teeth in pregnant women (standardized coefficient (SC) = 0.089; p = 0.008). Addictive risk behaviors were highly correlated, with SCs of 0.679 (p < 0.001) for alcohol and smoking, and 0.262 (p < 0.001) for soft drink and alcohol consumption. Obesity (SC = 0.081; p = 0.048) and added sugar consumption (SC = 0.142; p = 0.040) were interconnected across generations from pregnant women to their offspring. Children's consumption of sugar was strongly associated with CODB (SC = 0.357; p = 0.005). Caries and periodontitis were correlated in pregnant women. Obesity and sugar consumption have intergenerational impacts. Early sugar intake relates to CODB in early childhood. Intergenerational behavioral risks affect oral health in the first 1000 days of life, influencing long-term health outcomes.

Maintaining Normal Serum Ferritin Levels During Pregnancy: A Randomized Controlled Trial of Daily versus Weekly Ferrous Sulfate

Background: Serum ferritin is the most reliable indication of stored iron in pregnancy, offering a noninvasive way to detect iron deficiency anemia before it occurs. Therefore, this study aimed to determine serum ferritin levels among women receiving daily versus weekly iron supplementation, with a secondary focus on comparing the proportion developing iron deficiency anemia and compli-ance rates between the two groups.Methods: This non-blinded randomized control trial involved non-anaemic pregnant women attend-ing antenatal clinics at two Teaching Hospitals in Osun State. One hundred twenty-five subjects were recruited to receive 65mg in the control group, while another 125 subjects in the active group re-ceived three tablets (195mg) of ferrous sulfate (Fesulf) once weekly for 17 weeks from the 20th to 37th weeks of gestation. The primary outcome measure was comparing mean serum ferritin levels in both groups at 37 weeks.Results: Among the 240 subjects analyzed, the 37-week serum ferritin level was higher in the daily group (73.26±26.67μg/L) compared to the weekly group (63.04±30.71 μg/L), p value=0.006. Four (3.36%) and 10 (8.26%) of our subjects had Iron deficiency anaemia. Nine subjects (3.75%) reported dyspepsia as a side effect. Daily 65 mg of Felsulf proved more effective than weekly 195mg in main-taining normal blood ferritin levels during pregnancy.Conclusions: Daily iron supplementation with 65mg ferrous sulfate was more effective at main-taining adequate maternal iron concentration in this group of non-anaemic pregnant women. This dosage is recommended for routine iron supplementation in our environment.

Periconceptional Supplementation with Folic Acid or Multiple Micronutrients Containing Folic Acid and the Risk for Hypertensive Disorders in Pregnancy

Objective: The aim of this study was to investigate the association between supplementation containing folic acid only (FAO) or multiple micronutrients containing folic acid and the risk for hypertensive disorders in pregnancy (HDP). Subjects and Methods: The retrospective cohort study was based on data from women who gave birth from 2016 to 2018 at Tongzhou Maternal and Child Health Care Hospital of Beijing, China. The outcomes were HDP diagnosed after the 20th week of pregnancy, including gestational hypertension (GH), preeclampsia, and eclampsia. Associations between supplementation patterns and HDP were estimated by Poisson loglinear regression models. Sensitivity analyses were based on prepregnancy body mass index (BMI) and maternal age. Results: Among the 25,866 women included in the study, periconceptional use of FA supplementation marginally reduced the risk for HDP (adjusted risk ratio [aRR] = 0.87, 95% confidence interval [CI] 0.73–1.04). Women who began FAO supplementation before conception had a lower risk for GH compared to those who began after conception (aRR = 0.59, 95% CI: 0.45–0.78). The risk for HDP also reduced among FAO users who began supplementation before conception with a normal prepregnancy BMI (aRR = 0.64, 95% CI: 0.49–0.84) and users ≥30 years old (aRR = 0.75, 95% CI: 0.58–0.98). Conclusions: Periconceptional FAO supplementation may reduce the risk for HDP, especially GH. The protective effects are greater among women with a normal prepregnancy BMI and those ≥30 years old.

Correlation of Gestational Age with Anterior-Posterior Thigh Diameter Measured by Two-Dimensional Sonography

Background: Anterior-posterior thigh diameter measurement via two-dimensional sonography (2D-US) correlates with fetal gestational age and reflects the growth and development of fetal thigh muscles and bones. This measurement, alongside estimated gestational age, offers valuable insights into fetal well-being and growth during pregnancy. This study aimed to evaluate the correlation of gestational age with anterior-posterior thigh diameter measured by two-dimensional sonography and estimated gestational age. Methods: This cross-sectional study was conducted at the Department of Radiology and Imaging, Mymensingh Medical College &amp; Hospital, Mymensingh, Bangladesh from January 2010 to January 2012. As the study subjects, a total of 250 healthy women between the 24th and 38th weeks of normal pregnancy were enrolled by using a purposive sampling technique. For data analysis, SPSS version 23.0 was used. Results: The mean age of the participants was 24.79 ± 4.71 years with a range from 18 to 35 years. More than one-third (34.0%) of the women were in the age range of 21-25 years. The mean gestational age of all participants was 30.93 ± 4.32 weeks. Primigravida accounted for more than half (56.4%) of them. A statistically significant positive correlation was observed between fetal anterior-posterior thigh diameter and gestational age (p&lt;0.001. Conclusion: There is a statistically significant positive correlation between fetal anterior-posterior thigh diameter and gestational age.

Classic ear moulding technique for a lop ear deformity: case report

Introduction and importance: Lop ear is a congenital auricular deformity (CAD) detected at birth. It can negatively impact aesthetic appearance and the mental health of both the parents and the infant. Therefore, a treatment initiated at an early age is imperative. Case presentation: A male newborn patient on his 11th week of his life presented with his mother to the Maxillofacial Prosthodontic Unit. The extraoral examination showed a pendulous upper part of the auricle covering the antihelix with no deficiencies. The newborn’s hearing function was normal and no associated syndrome was identified. The patient was diagnosed with congenital unilateral lop ear (Tanzer grade II constricted ear). A non-surgical correction with a classic ear moulding device was attempted at the 11th week after birth to reshape the abnormal ear. Clinical discussion: Congenital auricular deformities (CADs) are traditionally managed by an otoplasty at age 6. Unfortunately, this option can cause many unpredictable complications, such as anaesthesia risks and under-correction. Therefore, the classic non-surgical correction of congenital auricular deformities is a non-surgical and earlier alternative to otoplasty. Moreover, many patient present at an older age; an auricular moulding device can still be a successful treatment option for these older patients. Conclusion: Classic ear moulding is an early non-surgical alternative to otoplasty for managing congenital ear abnormalities. It can be initiated as early as 6 weeks after birth. Including an ear examination as a routine in every child’s immediate post-birth physical examination is crucial for early diagnosis and better outcomes.

Predictive value of serum inflammatory markers in retinopathy of prematurity

PurposeTo evaluate the relationship between the development of retinopathy of prematurity (ROP) and neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR).Material and methodsThe medical records of 153 preterm infants born before the 34th week of gestation, were retrospectively reviewed. Complete blood cell (CBC) and C-reactive protein (CRP) results measured within the first 24 h of life were recorded. NLR, LMR and PLR were calculated by dividing neutrophil count by lymphocyte count, lymphocyte count by monocyte count, and platelet count by lymphocyte count, respectively. Analysis of possible risk factors related with ROP development was evaluated using logistic regression analysis. Results were compared between infants with and without ROP.ResultsA total of 153 infants, of which 64 (41.9%) with ROP and 89 (58.1%) without ROP, were included in the study. While lymphocyte count and LMR were found to be significantly lower in infants with ROP (p = 0.015 and p = 0.044), neutrophil count and NLR were found to be significantly higher (p = 0.021 and p = 0.046, respectively). No significant difference were observed in platelet and monocyte count and PLR (p = 0.808, p = 0.170 and p = 0.075, respectively). Multivariate logistic regression analysis revealed that gestational age, birth weight and NLR were major risk factors for the development of ROP (OR:0.59; p = 0.01, OR:1.00; p = 0.02 and OR: 2.56; p = 0.02, respectively).ConclusionThis study supports that, in addition to prematurity, NLR on the first postnatal day has a significant predictive value in ROP.

Correlation of Estimated Gestational Age with the Anterior-Posterior Thigh Diameter and Other Parameters of Fetal Biometry

Background: Accurate gestational age estimation is vital for tracking pregnancy, identifying growth issues, and guiding clinical decisions. Including anterior-posterior thigh diameter (APTD) in fetal biometry enhances fetal health assessment. Correlating EGA with APTD and other biometry parameters is crucial for evaluating fetal growth and development. This study aimed to evaluate the correlation of estimated gestational age with the anterior-posterior thigh diameter and other parameters of fetal biometry. Methods: This cross-sectional study was conducted at the Department of Radiology and Imaging, Mymensingh Medical College &amp; Hospital, Mymensingh, Bangladesh, from January 2010 to January 2012. A total of 250 healthy women between the 24th and 38th weeks of normal pregnancy were enrolled using a purposive sampling technique. Data analysis was performed using SPSS version 23.0. Results: More than one-third (34.0%) of participants were aged 21-25 years. The mean gestational age was 30.93 ± 4.32 weeks, and over half (56.4%) were primigravida. Significant positive correlations were found between fetal anterior-posterior thigh diameter and gestational age (r=1.0; p&lt;0.001), bi-parietal diameter (r=0.856; p&lt;0.001), head circumference (r=0.962; p&lt;0.001), abdominal circumference (r=0.972; p&lt;0.001), and femur length (r=0.948; p&lt;0.001). Conclusion: The fetal anterior-posterior thigh diameter shows significant positive correlations with several parameters, including gestational age, biparietal diameter, head circumference, abdominal circumference, and femur length in this study.

Dengue outbreaks in Brazil and Latin America: the new and continuing challenges

ObjectivesTo compare the number of suspected cases, severe cases, and deaths of dengue in 2023 and 2024 in Brazil and Latin America; and to describe its epidemiological profile. DesignObservational study. MethodsThe data regarding dengue was retrieved from the Brazilian Ministry of Health website. The Chi-square test was used to compare the proportion of dengue cases in 2023 and 2024 according to gender, race, and age range. The odds ratio and the 95% confidence intervals were used to describe the data. The Spearman correlation test was used to compare the number of suspected cases, severe cases, and deaths of dengue with the number of distributed vaccines against dengue. ResultsDengue is one of the most common zoonoses in Latin America. In 2023, Brazil registered a total of 1,658,814 suspected cases of dengue with 1094 deaths. For 2024, a total of 1,978,372 suspected cases of dengue were reported only until the 11th epidemiological week, with 656 deaths. When comparing dengue cases reported in 2024 and 2023, there is an increase in suspected cases, with 20% more cases reported during the first 11 epidemiological weeks of 2024 than in the entire 52 epidemiological weeks of 2023. At the same time, in 2024, the Pan American Health Organization reported suspected cases in 20 Latin American countries, with 3073 cases of severe dengue and 1187 deaths. In Brazil, a different racial profile for dengue was described since Black people [OR = 1.56 (95% CI = 1.54-1.57)], Mixed individuals [OR = 1.36 (95% CI = 1.35-1.37), and Indigenous peoples [OR = 1.77 (95% CI = 1.70-1.85)] were more likely to be suspected cases of dengue in 2024 compared to 2023. Also, a positive correlation between the distributed vaccines with deaths due to dengue and the number of severe cases was described. ConclusionBrazil was responsible for more than 50% of suspected cases and deaths from dengue compared to the other Latin American countries in 2024. Furthermore, there is a different racial profile for dengue in Brazil, as Black people, Mixed individuals, and Indigenous peoples were more likely to be suspected cases of dengue in 2024 compared to 2023.

PROGNOSTIC FACTORS FOR THE DEVELOPMENT OF SEPSIS IN POSTPARTUM WOMEN WHO HAVE SUFFERED CRITICAL OBSTETRICAL CONDITIONS

The aim of the research. To identify prognostic factors for the development of sepsis in postpartum women who have suffered critical obstetric conditions (CAC). Materials and methods. We retrospectively examined 39 postpartum women after CAC, who were divided into groups: A – main group, with advanced sepsis (n = 18), B – control group without sepsis (n = 21). An analysis of clinical data upon admission was carried out. The results were processed using Statistica 12.0, Microsoft Excel and in the R environment. Results. Statistically significantly more often, patients in the main group gave birth before the 34th week of pregnancy, p = 0.04. About 50% of the subjects gave birth in first-level maternity facility. Preeclampsia and obstetric hemorrhage were the main causes of CAC development. Hemorrhagic shock occurred in 84,6% of subjects. All women underwent total hysterectomy. Sepsis developed on day 9 (4; 9) after delivery. It was shown that the chance of developing obstetric sepsis is 28 times more often in the case of artifical ventilation and at AVPU, 10 times – in case of adult respiratory distress syndrom, 7 times – in case of developed kidney failure, 6 times – in case of cerebral edema. When assessing the condition of postpartum women using the integral scales APACHE II, APACHE III, SOFA, NEWS2, a statistically significant OR in the development of sepsis remains only for the NEWS2 index; with a score of 4 points, the resulting model predicts the development of sepsis. The risk of developing obstetric sepsis is associated with MNO ≥ 1,13, CVP ≥ 6 and ASAT ≥ 45; in the presence of at least one of these factors, it increases by 7-8 times in terms of odds ratio (OR). Conclusion. The risk of developing obstetric sepsis in critical obstetric conditions is associated with the presence of mechanical ventilation and AVPU, adult RDS, renal failure, cerebral edema, a NEWS2 score of 4 or more points, MNO ≥ 1,13, CVP ≥ 6 and ASAT ≥ 45. The effectiveness of the developed prognostic model is: sensitivity – 94,5%, specificity – 90,5%.

Agenecy of the corposion callosum: report of a clinical case

The agenesis of the corpus callosum (ACC) supposes an interhemispheric disconnection due to lack of formation of said structure in the embryonic development. Prevalence: 0.3-0.5% in the general population and 2.3% in people with disabilities. It is associated with prematurity and advanced maternal age. Agenesis of the corpus callosum is a malformation that can occur in isolation or in association with other systemic or central nervous system disorders and is one of the most common malformations in the brain, with an estimated prevalence of 1 in 4,000 live births. Among the most common clinical findings are mental retardation, visual problems, and seizures. Prenatal diagnosis can be made by ultrasound and magnetic resonance imaging from the 20th week of gestation. Postnatal diagnosis can be made by ultrasound, computed tomography, and magnetic resonance imaging. Currently, there is no specific treatment, although it has been proposed to start an early stimulation program and, if possible, a psychomotor rehabilitation program that offers improvement in motor and learning disorders.

Prenatal affective bond: a longitudinal study in women who achieved pregnancy through assisted reproduction

The prenatal maternal affective bond can be understood as the emotional relationship that a pregnant woman establishes with her unborn child. This prenatal relationship develops gradually during the entire pregnancy. To study the prenatal maternal affective bond, and the variables involved therein, over the entire gestation for women who achieved pregnancy through assisted reproduction techniques (ART). We conducted a longitudinal study in which we evaluated 49 women at the three gestational trimesters: after the ultrasound confirmation of heart beat (from the 6th – 7th week of pregnancy), around the 20th week of gestation, and as of week 34. This study reflects, among other issues, that the prenatal maternal affective bond is very high from the beginning of pregnancy and increases trimester-by-trimester, showing very high levels at the end of the pregnancy. While the small number of participants has limited the statistical power, the data obtained are a first approximation to the studied reality that allows us to identify variables on which to continue working in future studies.

Early prediction of bronchopulmonary dysplasia in extremely premature infants: a cohort study

Objective. To develop the model for early prediction of clinically significant bronchopulmonary dysplasia in extremely premature infants. Materials and methods. 226 premature infants with gestational age less than 31 weeks, birth weight from 490 to 999 g, age from 0 to 7 days, and respiratory failure requiring ventilatory support (ventilator support) were included into a retrospective study conducted in the Perm Regional Perinatal Center. Machine learning algorithms such as logistic regression, support vector machine, random forest method, and gradient boosting method were used for the prognostic model building. Five variables were used: birth weight, Apgar score in the 5th minute of life, Silverman score, number of days of invasive ventilatory support, median oxygen fraction in the inhaled air measured daily during the first seven days of life. Results. In the 36th week of postconceptional age 148 out of 182 infants (81.3%) in the study cohort developed bronchopulmonary dysplasia (BPD), among them 15.4% had a mild form, 29.7% a moderate one, and in 36.3% of patient it was severe. Among the four studied prediction algorithms, logistic regression model was chosen as the final model with metrics: AUC=0.840, accuracy 0.818, sensitivity 0.972, specificity 0.666. The practical application of the modeling results was implemented in the form of a probability calculator. Conclusions. In the early neonatal period of extremely premature infants, a combination of clinical predictors such as birth weight, Apgar score in the 5th minute of life, Silverman score, number of days of invasive ventilatory support, median oxygen fraction in the inhaled air measured during the first seven days of life can be used to predict the development of bronchopulmonary dysplasia. The logistic regression model shows high sensitivity that minimizes the probability of an error of second kind. Thus, its application is useful in the early prediction of bronchopulmonary dysplasia in premature infants.

Congenital cervical teratoma

: Teratoma, originating from the Greek word "teras" meaning "monster," reflects its diverse tissue composition, often containing ectodermal, mesodermal, and endodermal tissues. These embryonic germ layers contribute to the rarity of teratomas in the neck, though they are more commonly found in the sacrococcygeal area. Notably, teratomas occurring in the cervical region can lead to life-threatening symptoms due to their mass effect.: A 26-year-old multiparous woman highlighted the challenges of managing cervical teratomas. During her 38th week of gestation, an ultrasound revealed a tumour on the foetus's neck, measuring 5.2 x 4.7 cm with doppler, neovascularization, and solid parts suspected to be a teratoma. The patient, despite no prior illness, had not taken prescribed vitamins during pregnancy. She underwent a caesarean section, delivering a baby girl weighing 3100 grams with an Apgar score of 8, who was found to have a solid mass in the posterior neck. The baby underwent surgery three days later, where 200-gram mass was removed and identified as a mature teratoma through anatomical pathology examination. The successful surgery allowed the mother and baby to return home in good condition.: Teratomas emphasized their diverse nature, with cervical teratomas mostly affecting females and originating from early aberrant germ cells. These tumours, often neuroepithelial, rarely become malignant. Diagnosis involves prenatal ultrasonography, aiding in intervention planning, while postnatal imaging guides surgical approaches.: Congenital teratomas pose challenges in prenatal diagnosis and management, requiring a multidisciplinary approach. Early detection through antenatal imaging, surgical excision, and meticulous follow-up are crucial for optimal outcomes, emphasizing the importance of comprehensive care and collaboration across medical specialties.

EVALUATION OF TIME AND COST PERFORMANCE ON THE GX OFFICE &amp; CO WORKING BALI PROJECT USING THE EARNED VALUE METHOD

In rapid construction developments, delays still occur frequently and have not been resolved, as experienced by the GX Office &amp; Co Working Bali project. The project will be completed in 42 weeks, but in the 27th week, there is an indication of a delay of -4.31% from the initial plan. Earned Value Method (EVM) is a time and cost performance assessment method that can be used to develop strategies to minimize delays. This research aims to evaluate the time and cost performance of the GX Office &amp; Co Working Bali project using the EVM method. A quantitative approach is used to collect and analyze project schedules, actual costs, and progress reports. EVM key indicators such as Planned Value (PV), Earned Value (EV), and Actual Cost (AC) are analyzed to determine Schedule Variance (SV), Cost Variance (CV), Schedule Performance Index (SPI), and Cost Performance Index (CPI). The results showed that the project experienced delays, especially from week 1 to week 14 and week 19 to week 27, with SPI values mostly below 1. However, the project showed increased efficiency in cost management with values CPI above one after week 14 to week 27, indicating that the actual costs incurred are lower than the value of the work completed. These findings highlight the need for corrective actions and more effective management strategies to address delays efficiently in terms of costs.