Dysphagia Research Articles

REABILITAÇÃO OROFACIAL EM PACIENTES COM FISSURAS LABIOPALATINAS: RELATO DE EXPERIÊNCIA

Cleft lip and palate are classified as the most common malformations affecting the lip, resulting from anatomical flaws in facial processes. When left untreated, they cause aesthetic, functional and psychosocial complications, affecting collective interactions. This study aims to describe the experience of the clinical routine in a reference center, in which FUNDEF – Foundation for Rehabilitation of Craniofacial Deformities and Auditory Rehabilitation was selected, regarding the rehabilitation of patients with cleft lip and palate, improving knowledge regarding multidisciplinary care. We will address the first surgery performed, postoperative period, difficulties in feeding and speaking, social interaction, treatments performed during childhood, as well as treatments performed in adulthood. The reference center in question offers multidisciplinary treatment, such as dentists, speech therapists, psychologists, nutritionists, and others. Finally, the aim of this work is to address the multidisciplinary treatments performed on patients with cleft lip and palate.

The genotype and phenotype correlation of Prader-Willi syndrome

Prader-Willi syndrome (PWS) is a multifaceted congenital disorder resulting from the absence of paternally imprinted genes on chromosome 15q11.2-q13.1. Its clinical features vary with age, initially presenting as severe hypotonia and feeding difficulties in infancy, followed by hyperphagia in early childhood, ultimately leading to significant obesity. According to the underlying mechanism, the PWSs are divided into three main types. The deletion type with only one maternal copy accounts for 65%-75% of patients and may be divided into subtypes I to IV. Maternal uniparental disomy (mUPD) has two maternal copies, accounting for 20%-30% of patients, and is divided into the isodisomy subtype and heterodisomy subtype. Imprinting defects account for less than 5% of patients and are divided into epimutation and imprinting center deletions. The genotype-phenotype correlation has recently been investigated. Differences in the frequency and severity of specific features among various genotypes, particularly between deletion and mUPD types, have been reported. Herein, we reviewed the current literature and evidence on the genotype-phenotype correlation in PWS, which may help us to understand the mechanism and reasonable management of PWS.

Maple syrup urine disease diagnosed in a resource-limited setting in an infant in Nepal: a case report

BackgroundMaple Syrup Urine Disease (MSUD) is a rare inherited disorder of metabolism, which manifests early in life in classical forms. Recurrent illness and exertion aggravate neurotoxicity. This case highlights MSUD diagnosed in association with COVID-19 complications from Nepal.Case presentationWe present a case of a 4-month-old child with a biochemical diagnosis of flared-up MSUD. Initially presenting with chief complaints of fever, noisy breathing, chest retraction, cough along with lethargy and poor feeding since the first week of life, the child also had developmental delay with feeble neck holding and absent social smile. The child was diagnosed with COVID-19 pneumonia and admitted in the Intensive Care Unit, requiring mechanical ventilation for 12 days. Despite the clinical resolution of pneumonia, the child had multiple episodes of generalized seizures and was sickly and frail. An incessant peculiar odor emanating from the child led to strong suspicion of metabolic disorder. Qualitative screening for amino acids (FeCl3 and 2,4-dinitrophenylhdrazine/DNPH) in urine and further gas chromatography-mass spectrometry revealed increased branched-chain amino acids(valine, leucine, and isoleucine). With dietary restrictions, the child was doing well. However, unfortunately, after 10 days of discharge, the child succumbed to death.ConclusionsThis case highlights the outpouring of hidden metabolic disorders with the onset of new diseases. It could have been detected and managed earlier with expedited neonatal screening and proper intervention.

The Purpose of Researching Amyotrophic Lateral Sclerosis

The neurological system is affected by a disease called amyotrophic lateral sclerosis that affects nerve cells in the brain and spinal cord. This paper examines several facets of the disease's presentation characteristics, alterations in the illness, and contributing variables and therapeutic approaches. Speech slurring, difficulty swallowing, and arm or leg twitching and paralysis are common initial symptoms of amyotrophic lateral sclerosis. ALS gradually weakens the capacity to control the muscles involved in breathing, eating, speaking, and moving. The brain's capacity to start and regulate voluntary motions is lost. The muscles eventually become non-functional, twitch (a condition known as fasciculations), and atrophy (the loss of muscle mass). This sickness will be caused by a multitude of elements, such as age, gender, and certain genetic information. Additionally, topics like the signs and symptoms of ALS and the possible "treatments" for the illness are covered. There is essentially no chance of a cure for this deadly illness. The symptoms worsen with time because the condition is progressive. That does not, however, imply that individuals should give up looking for a remedy.

The possible association of two novel heterozygous GNB1 variants with obesity and metabolic disorders.

Variants in the GNB1 gene, which encodes for the beta-1 subunit of G proteins, have been associated with intellectual development disorder (OMIM: 616973), characterized by developmental delay, infantile hypotonia, seizures, and psychiatric problems. GNB1 variants may also cause a multisystem disorder, with symptoms such as hearing and vision impairment, gastrointestinal disorders, genitourinary abnormalities, and growth delay. We present two pediatric patients with two novel GNB1 variants. The first patient is a 12-year old Caucasian European female with a history of neonatal hypotonia, feeding difficulties, and failure to thrive for the first 2 years of life. Subsequently, she developed grade 3 obesity, hyperphagia, and autoimmune thyroiditis. Whole Exome Sequencing (WES) revealed a novel likely pathogenic variant in the GNB1 gene (NM_002074.5:c.93_94del, p.Gln32AspfsTer46), which is predicted to result in a loss or disruption of normal protein function through nonsense-mediated decay (NMD) or protein truncation. The second patient is a 2-year old Roma female with severe failure to thrive during infancy, congenital hypothyroidism, and transient hyperoxaluria. No developmental delay was identified. Genetic testing excluded primary hyperoxaluria and WES revealed to be a novel likely pathogenic variant {NM_002074.5:c.183G > T (NP_002065.1:p.Met61Ile), which is predicted to have a damaging effect on the gene or gene product. We present two rare pediatric cases with novel GNB1 variants which highlight the phenotypic variability associated with disrupted GNB1 expression. GNB1 may serve as a candidate gene for severe early onset obesity, hyperphagia, neurodevelopmental delay, and other metabolic and endocrine disorders.

The evolution of nutritional care in children with food allergies - With a focus on cow's milk allergy.

Cow's milk allergy (CMA) remains one of the most common and complex paediatric food allergies. In the last decade, our understanding has advanced in terms of immunoglobulin E (IgE)-mediated CMA and focus is now also paid to non-IgE-mediated CMA, particularly in some Western countries where incidence rates are high. We have had significant progress in the last 10 years in relation to our understanding of existing supportive tests for IgE-mediated CMA, with the advancement of newer tests, such as the basophil activation test (BAT), which have shown great promise. However, little advancement has been made in terms of tests for non-IgE-mediated CMA, and controversy still exists around symptoms. Our understanding of the natural history of CMA has also advanced with more awareness of different phenotypes. While the mainstay of management remains cow's milk elimination, the importance of supporting breastfeeding and avoidance of unwarranted cow's milk elimination diets in breastfeeding mothers has been highlighted. For non-breastfed children, there has been some advancement in the formulas offered for the management of CMA, including the recognition of hydrolysed rice-based formulas and increased demand for nutritionally complete plant-based options, some of which are currently being assessed. The addition of pro, pre and synbiotics is considered safe to use, although research and guidance on routine use remain absent. Knowledge of tolerance induction from studies on the early introduction of peanuts has also highlighted the importance of a more active approach to managing CMA with the use of milk ladders, primarily in non-IgE-mediated CMA and baked milk (BM) introduction in IgE-mediated CMA. In addition, modulation of the microbiome and diet diversity during complementary feeding has been a major advancement in the last 10 years. While data on poor growth and feeding difficulties in children with CMA has not changed much, increased rates of obesity are now also reported. Finally, novel approaches, including oral immunotherapy, the use of milk ladders and earlier consideration of BM, have advanced somewhat in the last decade, although the risks and benefits of these novel approaches require further research. While CMA remains a complicated allergy to diagnose and manage, the evolution of science has advanced our knowledge and brought some novel innovations, which combined have enhanced our practice.

Surgical Assisted Rapid Maxillary Expansion in Hemifacial Syndrome Patient Post Primary Cleft Treatment: A Case Report

Introduction: Cleft lip and palate is a congenital malformation resulting from an incomplete or incorrect fusion during embryonic development. Hemifacial syndrome is one of rare orofacial anomalies with midface hypoplasia. Maxillomandibular deformity repair for maxillary hypoplasia can be achieved by repositioning the maxilla and mandible to correct occlusion, mastication, functional issues, cosmetic concerns, and facial symmetry. The main concerns in the case of maxillary hypoplasia are the repair of transverse (narrowing of the maxilla), sagittal (anterior posterior), and vertical (facial proportion) aspects. This study aimed to elucidate the treatment for patients with maxillary hypoplasia by utilizing the surgical assessment of rapid maxillary expansion (SARME) following cleft lip and palate surgery. Case Report: A 21-year-old female patient had symptoms of a truncated maxilla, compromised speech, and challenges with mastication and ingestion. The patient’s surgical history includes having undergone labioplasty, palatoplasty in 2002, and gnatoplasty in 2023. The recommended treatment for this situation involves SARME. The patient’s speaking and feeding difficulties were caused by both transversal and vertical problems in the patient with maxillary hypoplasia. This is why the therapy was necessary. Case Management: Implementation of surgical assessment rapid maxillary expansion (SARME). Conclusions: This case report concludes a notable improvement in the upper and lower jaw’s functional, masticatory, and aesthetic aspects in a patient with maxillary hypoplasia. This improvement was achieved with surgical assisted of rapid maxillary expansion (SARME) following primary cleft lip and palate surgery. Keywords: Cleft lip and palate, Hemifacial syndrome, SARME

Management of Tessier No. 2 Facial Cleft Using Millard Technique with Zig- Zag Ad-vancement Flap: A Case Report

Introduction: Craniofacial cleft is a rare congenital disorder that affects facial and skull. development, with an incidence estimated between 1.4-4.9 per 100,000 births. This condition often results in significant complications such as feeding difficulties, impaired speech, hearing issues, and psychosocial challenges. Among craniofacial clefts, the oblique facial cleft, including Tessier No. 2 cleft, is the rarest and least documented. This cleft is characterized by specific soft and hard tissue deformities resulting from a failure of fusion among facial processes during embryonic development. Case: An 8-month-old female presented with a unilateral cleft of the lips, gums, and palate on the left side, accompanied by a Tessier No. 2 facial cleft. The patient's mother reported no history of teratogenic exposure or family history of clefts. Clinical examination revealed hypoplasia of the middle third of the nasal margin, a flattened lateral nose, a widened nasal bridge, and a deviated nasal septum. The patient was diagnosed with unilateral complete labiognatopalatoschizis accompanied by Tessier No. 2 cleft. Case Management: The patient was prepared for labioplasty under general anesthesia after meeting the "rules of ten" criteria (10 weeks old, 10 pounds, 10 grams/dl hemoglobin). The surgery was performed using the Millard technique with a zig-zag advancement flap to achieve optimal tissue coverage and symmetry. Postoperative care included antibiotics, pain management, and follow-up visits. At the 3-month follow-up, the surgical site showed good healing with no signs of infection or significant complications. Conclusion: Understanding the specific anatomy and pathophysiology of Tessier No. 2 clefts is essential for effective surgical planning and outcomes. The modified Millard technique provides satisfactory aesthetic and functional results, although challenges remain. Comprehensive postoperative management and long-term follow-up are crucial to monitor healing and address any complications. Further research and multidisciplinary.Keyword: Facial Cleft, Tessier 2, Millard Technique, Zig-zag Advancement Flap

Can Multiple Sclerosis-Related Symptoms Determine Sleep Disorders?

BACKGROUND: Sleep disorders are common and various in persons with multiple sclerosis (PwMS). However, their assessment and management remain in the background compared with motor symptoms. This study was conducted to better understand sleep disorders in PwMS and to analyze sleep problems and their predictive symptoms. METHODS: This cross-sectional design study was conducted with 136 PwMS. Data were collected using a participant identification form, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, and Stop-Bang Test. In data analysis, 1-way analysis of variance, t test and Pearson correlation, and multiple regression analysis were used. RESULTS: The study found that 51.5% of the participants have poor sleep quality, 36.8% have insomnia, 24.3% have excessive daytime sleepiness, and 19.9% were at risk of obstructive sleep apnea. Symptoms of forgetfulness (β = 0.199), depression (β = 0.223), pain (β = 0.278), and increased urinary frequency at night (β = 0.236) explain approximately 40% of the change in sleep quality score; difficulty swallowing (β = 0.218), depression (β = 0.253), and pain (β = 0.313) symptoms explain 33% of the change in insomnia score; fatigue (β = 0.292) and anxiety (β = 0.409) symptoms explain 32% of the change in sleepiness score. CONCLUSIONS: PwMS start to experience sleep disorders in the early stages of the disease, some characteristics affect sleep disorders, and the symptoms they experience explain sleep disorders at significant rates. Sleep disorders should be evaluated by nurses and interdisciplinary healthcare teams from the early stages of multiple sclerosis with different aspects and to include predictive symptoms in the interventions to be implemented to reduce sleep disorders.

Cyclin‐dependent kinase 13 is indispensable for normal mouse heart development

AbstractCongenital heart disease (CHD) has an incidence of approximately 1%. Over the last decade, sequencing studies including large cohorts of individuals with CHD have begun to unravel the genetic mechanisms underpinning CHD. This includes the identification of variants in cyclin‐dependent kinase 13 (CDK13), in individuals with syndromic CHD. CDK13 encodes a serine/threonine protein kinase. The cyclin partner of CDK13 is cyclin K; this complex is thought to be important in transcription and RNA processing. Pathogenic variants in CDK13 cause CDK13‐related disorder in humans, characterised by intellectual disability and developmental delay, recognisable facial features, feeding difficulties and structural brain defects, with 35% of individuals having CHD. To obtain a greater understanding for the role that this essential protein kinase plays in embryonic heart development, we have analysed a presumed loss of function Cdk13 transgenic mouse model (Cdk13tm1b). The homozygous mutants were embryonically lethal in most cases by E15.5. X‐gal staining showed Cdk13 expression localised to developing facial regions, heart and surrounding areas at E10.5, whereas at E12.5, it was more widely present. In the E15.5 heart, staining was seen throughout. RT‐qPCR showed significant reduction in Cdk13 transcript expression in homozygous compared with WT and heterozygous hearts at E10.5 and E12.5. Detailed morphological 3D analysis of embryonic and postnatal hearts was performed using high‐resolution episcopic microscopy, which affords a more detailed analysis of structures such as cardiac valve leaflets and endocardial cushions, compared with more traditional histological techniques. We show that both the homozygous and heterozygous Cdk13tm1b mutants exhibit a range of CHD, including ventricular septal defects, bicuspid aortic valve, double outlet right ventricle and atrioventricular septal defects. 100% (n = 4) of homozygous hearts displayed CHD. Differential expression was seen in Cdk13tm1b homozygous mutants for two genes known to be necessary for normal heart development. The types of defects, and the presence of CHD in heterozygous mice (17.02%, n = 8/47), are consistent with the CDK13‐related disorder phenotype in humans. This study provides important insights into the effects of reduced function of CDK13 in the mouse heart and contributes to our understanding of the mechanism behind this disorder as a cause of CHD.

Non-Nutritive Suck and Parent Report of Feeding Skills in Infants Born With Cleft Lip and/or Palate

Objective To compare non-nutritive sucking (NNS) and caregiver-reported feeding skills in infants with cleft lip and/or palate (CL/P) to a control group of typically developing infants without CL/P. To examine differences in NNS patterns and feeding behavior between cleft phenotypes. Design Prospective, cross-sectional study comparing infants born with CL/P to an age-matched control group with no congenital anomalies. Setting Urban, academic, tertiary care children's hospital and academic department of speech-language pathology. Patients, Participants Forty-two infants (21 with CL/P; 21 without CL/P), 6 months of age and younger were included. Infants with syndromes or who underwent cleft repair were excluded. Main Outcome Measures A 5min NNS sample was collected from the infant sucking on the lab's custom research pacifier. The infant's caregiver completed the Neonatal Eating Assessment Tool (NeoEAT) bottle-feeding section about their infant's feeding behaviors. Results Infants with CL/P demonstrated slower NNS frequency ( P = .04) and reduced suck amplitude ( P = .04) compared to the control group. Caregivers of infants with CL/P reported a higher incidence of gastrointestinal symptoms ( P = .04) and overall feeding difficulties ( P = .03) relative to the control group. There were no significant differences between CL/P phenotypes for NNS or caregiver reported outcomes. Conclusions Infants with CL/P demonstrate differences in NNS physiology and caregiver report measures of feeding compared to age-matched controls. These findings support the need for interventions to optimize sucking and feeding skill development in infants with CL/P.

Nutrients Composition of Acha Base Complementary Food Supplemented with Soybean and Sweet Potato Flour

Poor complementary food and feeding had been shown to increase the morbidity and mortality among under-five children in developing countries in which Nigeria is not exempted. This study aimed at evaluating the Nutrients Composition of Acha -Based complementary food supplemented with soybean and sweet potato flour. Raw materials used for the formulated of the complementary were purchased from Erekesan market in Akure Local Government Area of Ondo State. Five (5) samples were formulated in different ratios of Acha (100:70:60:50:40), Soyabean (20:25:30:35) and Orange flesh sweet potato (10:15:20:25). Samples were subjected to chemical and instrumental analysis in line with standard method. The data obtained were statistically analyzed using ANOVA to test for the significant difference among means (P<0.05) using Statistical Package for Social Science (SPSS version 22). Finding shows that Moisture, crude fibre, and carbohydrate was significantly (p<0.05) higher in sample Awhile, Sample E was significantly (p<0.05) higher protein (18.42%) and fat (12.40%) compared to other formulated samples. The Moisture, crude fibre, and CHO was significantly (p<0.05) decreases with decreased in the quantity of Acha use in the formulation of the CFs while crude fat, Ash and protein increases with increase in the quantity of soybean incorporated in the formulations. Sample E is significantly (P<0.05) higher in vitamin B1, B3 and B9 compared with sample A. vitamin B1, B3 and B9 increases with increase in the quantity of soybean and OFSP. All the samples have appreciable amount of sodium, calcium, phosphorus, magnesium and potassium but, zinc and iron was low in the entire sample. Sample E was exceptional in all the minerals but significantly (p<0.05) lower in Zinc and iron. The mean sensory scores revealed that sample C was different in after taste, flavour, mouth feel, colour and overall acceptability. The mean scores increase with increase in the proportion of soybean and potato in the formulated complementary food samples in terms of all the sensory attributes tested. The scores showed that sample C had the highest acceptability by the panelists. The complementary foods had improved nutrients that can support optimal nutrition of undernourished children and other older people.

Sosialisasi Pencegahan Bahaya Rabies dan Penaggulangan Pernikahan Anak di Usia Dini di Kabupaten Bone

Rabies can attack all types of warm-blooded animals and humans. Symptoms of rabies in humans usually begin with fever, headache, difficulty swallowing, fear of water, sensitivity to wind and sound stimuli and end in death. Control of rabies is generally done by vaccination and elimination of stray/wild dogs, in addition to socialization programs and supervision of rabies-transmitting animal traffic (HPR). While in early marriage, it has a negative impact on teenagers and when living in a family, early marriage can be caused by several factors, namely, social factors, economic factors, educational factors. Prevention of early marriage can be done by providing education about the dangers and impacts of early marriage

Cotoneaster Side Effects Following the Treatment of Neonatal Jaundice

Background: There has been significant interest in using Cotoneaster for treating jaundice or elevated bilirubin levels in newborns, and it has, in many cases, replaced phototherapy in herbal medicine. However, using these compounds to treat hyperbilirubinemia can lead to complications in neonates, potentially resulting in morbidity and even death. Objectives: This study examined the side effects of Cotoneaster consumption in jaundiced neonates admitted to the Children’s Medical Center between 2021 and 2022. Methods: We conducted a cross-sectional study involving healthy neonates who consumed Cotoneaster following treatment for neonatal jaundice and subsequently experienced complications. The data were recorded using pre-prepared questionnaire forms. Results: The most common complications following Cotoneaster derivatives were exaggerated hyperbilirubinemia, dehydration, and poor feeding. Conclusions: Given the sensitivity of neonates, the treatment of jaundice in babies should be approached with caution and supported by extensive studies. The use of herbal medicines in neonates remains questionable due to associated complications.

CHARGE syndrome in a neonate

A female infant, aged 11 days, was admitted due to dyspnea for 11 days after birth, with the main clinical manifestations of inspiratory dyspnea, feeding difficulties, and unusual facies (micrognathia, high palatal arch, cleft palate, glossoptosis, and oblique mouth to the right), and the preliminary diagnosis was Pierre-Robin syndrome. There was no marked improvement after treatment such as ventilator-assisted ventilation, nutrition, and surgical ligation of patent ductus arteriosus. Whole-exome sequencing of the family showed a heterozygous mutation of c.3082A>G (p.Ile1028 Val) in the CHD7 gene, which was a pathogenic mutation of CHARGE syndrome. The neonate was ultimately diagnosed with CHARGE syndrome, and the family decided to withdraw treatment due to concerns about poor prognosis. This article reports a case of CHARGE syndrome caused by a mutation in the CHD7 gene and the multidisciplinary diagnosis and treatment of this disease, in order to provide help for early disease identification and guide clinical decision-making.

Milk Value Chain Analysis: The Case of Urban and Peri-Urban Areas of Ambo and Dendi Districts, West Shewa Zone, Oromia National Regional State, Ethiopia

This study was aimed at analyzing value chain of milk in Urban and Peri – Urban areas of Ambo and Dendi districts of West Shewa Zone. The study made use of both primary and secondary data collected from 146 smallholder farmers, 30 consumers, 10 Hotels and Cafeterias and 2 primary milk cooperatives through application of individual interview schedules, focus group discussions and key informant interview. The analysis was made using descriptive statistics and value chain analysis. The value chain analysis revealed that the major actors in the districts milk value chains are input suppliers, milk producers, collectors, processors and consumers. Accordingly, the value chain activities in the chain were input supply, production, processing, marketing and consumption. Four milk marketing channels were identified and relative to all other fresh milk marketing channels, producers get a higher proportion of total gross marketing margin when they sell milk to cooperatives. Profitability analysis result for dairy production indicated that, a dairy producer obtains average gross margin of 83.65per improved cow per day, in the study areas which shows that dairy production was a profitable venture for smallholder dairy producers. Milk value chain in the study areas was hindered by shortage of feeds, continuous increasing price of feeds, poor AI service provision, poor supply of genetically improved cattle breeds, limited availability of credit services, limited extension service provision, poor feeding and animal husbandry practices, low level of market linkage among the value chain actors, absence of milk processing plant and non-market oriented milk production. Therefore, policy aiming at increasing farmers’ access to modern inputs, feed conservation practices, adequate training provision to AI technicians, developing and improving infrastructure, cooperative development and improving extension services are recommended to accelerate the milk value chain’s development in the study areas.

A One Health Approach to Reducing Livestock Disease Prevalence in Developing Countries: Advances, Challenges, and Prospects.

Challenges in livestock production in developing countries are often linked to a high disease prevalence and may be related to poor husbandry, feeding, and nutrition practices, as well as to inadequate access to preventive veterinary care. Structural barriers including chronic poverty, gender roles, inadequate supply chains, and limitations in surveillance infrastructure further complicate progress. Despite many challenges, the livestock sector substantially contributes to agricultural GDP, and reducing livestock disease prevalence is a goal for many countries. One Health initiatives that work across disciplines and sectors to reduce livestock diseases are underway around the world and use integrated approaches that consider the connections between humans, animals, and their shared environments. The growing recognition of the role livestock play in sustainability and livelihoods, as well as their involvement in zoonotic disease transmission and global health security, has highlighted the need for disease reduction strategies as described in this review.

Multidisciplinary Surgical Care for a Cervical Esophageal Duplication Cyst.

We present a case of a three-month-old male who presented with a cervical esophageal duplication cyst requiring early surgical intervention. The patient presented with feeding difficulties, poor weight gain, and respiratory distress. Due to the position of the cervical esophageal duplication cyst and airway compression, this unique case required a multidisciplinary surgical approach involving both otolaryngology and cardiothoracic surgery.

Epigenetics Embedding of Oral Feeding Skill Development in Preterm Infants: A Study Protocol.

Preterm infants face challenges to feed orally, which may lead to failure to thrive. Oral feeding skill development requires intact neurobehaviors. Early life stress results in DNA methylation of NR3C1 and HSD11B2, which may disrupt neurobehaviors. Yet, the extent to which early life stress impairs oral feeding skill development and the biomechanism whereby this occurs remains unknown. Our team is conducting an NIH funded study (K23NR019847, 2022-2024) to address this knowledge gap. To describe an ongoing study protocol to determine the extent to which early life stress, reflected by DNA methylation of NR3C1 and HSD11B2 promoter regions, compromises oral feeding skill development. This protocol employs a longitudinal prospective cohort study. Preterm infants born between 26 and 34weeks gestational age have been enrolled. We evaluate early life stress, DNA methylation, cortisol reactivity, neurobehaviors, and oral feeding skill development during neonatal intensive care unit hospitalization and at 2-week post-discharge. To date, we have enrolled 70 infants. We have completed the data collection. Currently, we are in the data analysis phase of the study, and expect to disseminate the findings in 2025. The findings from this study will serve as a foundation for future clinical and scientific inquiries that support oral feeding and nutrition, reduce post-discharge feeding difficulties and lifelong risk of maladaptive feeding behaviors and poor health outcomes. Findings from this study will also provide further support for the implementation of interventions to minimize stress in the vulnerable preterm infant population.

Case Report: Delayed Cerebral Ischemia with Infarction following an Undiagnosed Aneurysmal Rupture - The Diagnostic and Management Challenge

Delayed Cerebral Ischemia (DCI) typically occurs a few days after a patient suffers subarachnoid hemorrhage and can lead to a range of poor outcomes. It is primarily driven by vasospasm and its delayed and variable presentation complicates diagnosis and treatment. Here we report a case of DCI in a 31-yearold man who presented with acute onset aphasia, right-sided weakness, and difficulty swallowing. He had experienced a severe headache accompanied by nausea and vomiting 5 days prior, with an initial NIH stroke scale score of 10. Imaging revealed a left internal carotid artery aneurysm and a watershed infarct between the anterior cerebral artery and middle cerebral artery. The patient was treated with aneurysmal coiling, intraarterial verapamil, and oral nimodipine for suspected DCI secondary to subarachnoid hemorrhage. Close monitoring of the patient and treatment led to the resolution of neurological deficits over the subsequent days., with imaging confirming reperfusion. This case presents a unique challenge due to the delayed presentation and vague history. Diagnosis and treatment of DCI following aneurysmal rupture are complicated due to its delayed and variable onset. It is crucial to consider acute aneurysmal subarachnoid hemorrhage and DCI when evaluating patients who present with multiple stroke-like symptoms over several days as the management and prognosis differ from other cases of acute ischemic stroke.