Nonketotic hyperglycinemia is a rare metabolic disorder caused by glycine accumulation due to defects in the glycine cleavage system. While severe metabolic disorders can theoretically affect fetal growth, nonketotic hyperglycinemia is not recognized as a common or typical cause of symmetric intrauterine growth retardation. This case report describes a Iranian 36-week male neonate with symmetrical intrauterine growth restriction, born to consanguineous parents with a history of preeclampsia and prior fetal demise. Despite initial stabilization, the infant developed metabolic acidosis, recurrent apnea, and seizures. Laboratory findings revealed elevated glycine levels (2560µmol/L), confirming nonketotic hyperglycinemia. Despite seizure management and antibiotic therapy, the infant deteriorated and died on day 11. Nonketotic hyperglycinemia typically presents with lethargy, hypotonia, seizures, and apnea, often fatal in the neonatal period. Glycine's dual role as an excitatory and inhibitory neurotransmitter explains the seizures and hypotonia seen in nonketotic hyperglycinemia. While acute symptoms may resolve, survivors face severe neurological impairment. Early recognition of nonketotic hyperglycinemia is critical for genetic counseling and palliative care. This case highlights the diagnostic challenge of nonketotic hyperglycinemia, particularly when presenting with intrauterine growth restriction, which can mimic other neonatal conditions such as sepsis or hypoxic-ischemic encephalopathy. Consanguinity and prior fetal loss should raise suspicion for metabolic disorders, and according to this case presentation, symmetric intrauterine growth restriction in high-risk pregnancies should prompt metabolic screening. Despite advances, nonketotic hyperglycinemia remains a devastating condition with high mortality and neurodevelopmental morbidity, emphasizing the importance of further research and early intervention strategies.

Background: Tonsillectomy and adenoidectomy are among the most common otorhinolaryngological surgeries, indicated for recurrent tonsillitis, adeno-tonsillar hypertrophy, and obstructive sleep apnoea. Histopathological examination of excised specimens aids in confirming diagnosis and detecting rare pathology. Methods: A prospective study was conducted at Gujarat Adani Institute of Medical Sciences, Bhuj, from June 2023 to November 2024. Seventy patients undergoing tonsillectomy and/or adenoidectomy were enrolled. Demographic profile, presenting symptoms, Brodsky grading, surgical details, and histopathological findings were analysed. Data were processed using SPSS v25.0. Results: The majority of patients were adolescents (11-20 years, 37.1%) with a female predominance (55.7%). The predominant symptom was throat pain (95.7%), followed by mouth breathing and snoring (12.9% each). Most patients presented with grade 3 tonsillar hypertrophy (74.3%), and symptoms of 1-3 years’ duration (71.4%). Bilateral tonsillectomy was the most common surgery performed (87.1%). Histopathological findings revealed chronic tonsillitis in 51.4% of cases, followed by chronic tonsillitis with actinomycetes (18.6%) and chronic lymphoid hyperplasia (15.7%). Rare findings included lymphoepithelial cysts (1.4%). Conclusions: Chronic tonsillitis remains the leading indication for tonsillectomy, with strong correlation between clinical and histopathological features. Early recognition and surgical intervention yield favourable outcomes. Routine histopathology remains indispensable tool in excluding uncommon benign and malignant lesions.

Preterm infants require human milk fortification to achieve adequate growth. Most fortifiers are bovine-derived and may trigger feeding intolerance or immunological reactions. We describe a 25+5 week, 720 g male infant who developed recurrent apnea, reflux, and dependence on respiratory support soon after initiation of bovine-based human milk fortifier (HMF). Investigations excluded sepsis and necrotizing enterocolitis. Stool calprotectin was markedly elevated, and eosinophilia was noted. Symptoms resolved rapidly after discontinuation of bovine HMF and initiation of a human milk-derived fortifier, with dramatic improvements in weight gain and respiratory stability. This case highlights cow’s milk protein intolerance (CMPI) precipitated by bovine fortifier and the therapeutic benefit of human milk-based HMF.

Background: Post-tonsillectomy bleeding (PTB) is one of the most concerning complications following tonsillectomy, with potential implications for patient morbidity and surgical outcomes. This retrospective study aimed to determine the incidence, pattern, and possible demographic risk factors associated with PTB in a tertiary care hospital setting. Methods: A retrospective review was conducted at Al Ahli Hospital, Doha, Qatar, including 329 patients who underwent tonsillectomy between September 2023 and August 2025. Patients with recurrent chronic tonsillitis or obstructive sleep apnea were included, while those with unilateral tonsillectomy, tonsillar biopsy, or suspected neoplasms were excluded. Data on demographic characteristics, timing of bleeding, and return to the operating room (OR) were analyzed using Fisher’s Exact Test, with p<0.05 considered statistically significant. Results: The overall incidence of PTB was 4.25%, comprising 0.30% primary and 3.95% secondary hemorrhage. Bleeding was more frequent in males (3.34%) compared to females (0.91%), and a slight increase in bleeding incidence was noted with age (0.91% in <5 years, 1.51% in 5–15 years, and 1.82% in ≥16 years). However, these differences were not statistically significant. Only 1.21% of patients required surgical intervention, and no cases required blood transfusion. Bilateral and contralateral bleeding were rare (0.30% each). Conclusion: PTB incidence in this cohort was low and predominantly secondary in nature. Although bleeding was more frequent among older and male patients, neither age nor gender significantly influenced the risk of reoperation. Consistent surgical technique and vigilant postoperative monitoring remain critical for minimizing bleeding-related complications.

Tonsillectomy is a common surgical procedure performed by otolaryngologists, primarily indicated for the management of recurrent tonsillitis and obstructive sleep apnea. While postoperative pain and hemorrhage are well-recognized complications, persistent dysphagia following tonsillectomy is rare. In such cases, a comprehensive evaluation is warranted to identify potential mechanical or functional causes. Psychogenic dysphagia is a diagnosis of exclusion and may significantly affect a patient's quality of life. Timely intervention, including detailed swallowing assessment and multidisciplinary team involvement, is essential for optimal recovery. This report presents a case of a 42-year-old male who underwent elective tonsillectomy complicated with secondary postoperative hemorrhage, followed by the development of severe dysphagia attributed to a psychogenic etiology.

Recurrent apnoea is common in preterm infants, particularly at very early gestational ages. These episodes of ineffective breathing can lead to hypoxaemia and bradycardia, sometimes severe enough to require resuscitation, including positive pressure ventilation. Various interventions have been used to manage apnoea of prematurity, including methylxanthines and continuous positive airway pressure (CPAP). However, CPAP and methylxanthines remain the most widely studied and utilised treatments due to their greater benefits and lesser harms compared to alternatives like CO₂ inhalation. To evaluate the benefits and harms of CPAP compared to methylxanthines for apnoea of prematurity in preterm infants. We searched CENTRAL, MEDLINE, Embase, CINAHL, three clinical trials databases, and conference proceedings. We checked references in included studies and related systematic reviews up to August 2024. We included all trials using random or quasi-random allocation to CPAP or any methylxanthine in preterm infants with clinical recurrent apnoea with or without bradycardia. We excluded infants with secondary apnoea, defined as apnoea secondary to causes other than prematurity. We excluded cross-over studies since the severity of apnoea of prematurity can change in either direction over time, but most commonly improves with time. We excluded studies that evaluated combined interventions, such as CPAP plus methylxanthines versus either CPAP or methylxanthines alone. Our critical outcomes were failure of treatment at any time point during hospitalisation, neurodevelopmental outcomes assessed at 18 to 24 months, death in the first year from any cause, bronchopulmonary dysplasia at 36 weeks' postmenstrual age (PMA), and adverse effects such as nasal trauma, tachycardia within the first 24 hours of treatment initiation, feeding intolerance, and pneumothorax. We used the Cochrane risk of bias tool (RoB 1) to assess the risk of bias in the studies. We conducted a structured narrative synthesis based on the Synthesis Without Meta-analysis (SWiM) reporting guidelines, as only one eligible study was included. We grouped results by outcome, and extracted absolute and relative effects. No meta-analysis or subgroup analysis was performed. We included one small randomised controlled trial (RCT) with a total of 32 participants, conducted in a high-resource setting and involving preterm infants. The trial compared CPAP and theophylline. CPAP compared to theophylline The evidence is very uncertain about whether there is any difference between CPAP and theophylline in failure of treatment during hospitalisation (risk ratio (RR) 2.89, 95% confidence interval (CI) 1.12 to 7.47; risk difference (RD) 0.42, 95% CI 0.11 to 0.74; 1 study, 32 participants; very low-certainty evidence). The evidence is very uncertain about whether there is any difference between CPAP and theophylline in death in the first year (RR 2.57, 95% CI 0.97 to 6.82; 1 study, 32 participants; very low-certainty evidence). In terms of adverse effects, nasal trauma, feeding intolerance, and pneumothorax were not reported. Only tachycardia was reported, but the evidence is very uncertain about whether there is any difference between CPAP and theophylline in tachycardia within the first 24 hours after treatment initiation (RR 0.10, 95% CI 0.01 to 1.60; 1 study, 32 participants; very low-certainty evidence). Bronchopulmonary dysplasia at 36 weeks' PMA and neurodevelopmental outcomes at 18 to 24 months were not reported in the included study. The overall risk of bias is high due to baseline imbalances, lack of blinding, and early trial cessation, which affects the reliability of the findings. From the single, small included study, performed more than 40 years ago, we are very uncertain whether there is any clinically meaningful difference in the effect of CPAP and theophylline on apnoea of prematurity. Both interventions, CPAP and theophylline, have largely been replaced by nasal prong CPAP and caffeine or aminophylline in modern neonatal care, limiting the applicability of these findings to current practice. However, since caffeine is not readily available in some low- and middle-income countries, and CPAP access remains limited in certain settings, further research may still be relevant. If further trials are conducted, these should use modern CPAP delivery methods and caffeine rather than theophylline. This is the second update of a review first published in 1998. This Cochrane review had no dedicated funding. This is an update of the existing review 'Continuous positive airway pressure versus theophylline for apnoea in preterm infants' originally published in The Cochrane Library, Disk 2, 1998 (Henderson-Smart d) and updated on Disk 4, 2001 (Henderson-Smart e). Previous versions are available via DOI: 10.1002/14651858.CD001072. The title was amended from 'Continuous positive airway pressure versus theophylline for apnoea in preterm infants' to 'Continuous positive airway pressure versus methylxanthine for apnoea in preterm infants' in May 2024.

Abstract IntroductionObstructive sleep apnea syndrome (OSAS) is an inflammatory disease characterized by recurrent apnea and hypopnea. Multidrug resistance protein 1 (MRP1) is an anti‐inflammatory protein that protects the cell from agents caused by oxidative stress. The aim of this study was to investigate the role of MRP1 in platelet function in OSAS.MethodsAccording to the polysomnography results, 14 patients with simple snoring, 16 with mild OSAS, 14 with moderate OSAS, and 15 with severe OSAS were included in the study. Platelet aggregations were evaluated by an aggregometer. MRP1, CD62P (P‐selectin), CD41b, and CD42b expressions were measured by a flow cytometer.ResultsPlatelet aggregation levels were higher in the severe OSAS group than in the simple, mild, and moderate OSAS groups (p = 0.041). On the other hand, CD42b+/MRP1+ expression was lower in the severe OSAS group than in the simple, mild, and moderate OSAS groups (p = 0.002). MRP1 and CD42b expressions were consistent with this result (p = 0.013, p = 0.009, respectively). A positive correlation was found between apnea/hypopnea index and platelet aggregation (r = 0.289 p = 0.028) and a negative correlation was found between CD42b, CD42b+/MRP1+ (r = −0.419 p = 0.001, r = −0.357 p = 0.006, respectively).ConclusionOur findings suggest that high platelet activity and low MRP1 expression contribute to inflammation in OSAS and thus may be biomarkers.

Obstructive sleep apnea (OSA) disrupts the oxygen supply during apneic and hypopneic events. To evaluate the feasibility of concurrently monitoring cerebral metabolic rate of oxygen (CMRO2) and airway anatomy, a magnetic resonance imaging (MRI) pulse sequence was developed that interleaves measurements of CMRO2 with anatomic imaging of the upper airway at a temporal resolution of 5 seconds. The sequence was first tested in healthy subjects during wakefulness to detect the effect of volitional breath-hold and swallowing apneas on neuro-metabolic parameters and airway morphology. Subsequently, select patients with diagnosed OSA and healthy reference subjects were scanned during 90 minutes of wakefulness and sleep with concurrent electroencephalographic (EEG) monitoring and airway plethysmography. During non-rapid eye movement sleep, changes in metabolic parameters caused by neurovascular-metabolic uncoupling were detected, resulting in sleep-stage dependent reductions in the CMRO2. Spontaneous apneas were visible in airway images and confirmed plethysmographically. Recurrent apneas in patients during N1 and N2 sleep led to increased SvO2 and CBF (hypercapnic-hypoxic response) and decreases in SaO2 (hypoxemic response from airway closure) resulting in CMRO2 reductions as large 60%. The results demonstrate the MRI potential of noninvasive assessment of the dynamic changes in airway anatomy and brain metabolism in OSA during sleep.

Congenital dengue is seen in endemic areas during monsoon seasons. The clinical manifestations can vary from an asymptomatic newborn to mild symptoms like fever and rash to severe manifestations like shock and bleeding. The neurological manifestations of congenital dengue are uncommon compared with older children. The described symptoms/complications in the literature include congenital birth defects such as microcephaly, encephalitis and intraventricular haemorrhage. Apnoea as a manifestation of dengue has not yet been described in the literature. Here, we discuss a newborn baby with congenital dengue who had recurrent apnoea with positive NS1 antigen in cerebrospinal fluid.

Background: Tonsillectomy, commonly performed for recurrent tonsillitis and obstructive sleep apnoea, is traditionally done in inpatient settings. However, ambulatory surgery is gaining popularity due to cost-effectiveness and faster recovery. In Sub-Saharan Africa, its feasibility remains underexplored. This study assessed eligibility criteria for ambulatory tonsillectomy in a Sub-Saharan country. Methodology: A cross-sectional study was conducted at Gyneco-Obstetric and Pediatric Hospital in Yaoundé, Cameroon, including patients undergoing tonsillectomy between January and September 2024. Eligibility for ambulatory surgery was based on preoperative factors such as age, comorbidities, and the ability to ensure post-operative care at home. Clinical and surgical data were extracted from records, while post-operative outcomes, including complications and recovery, were assessed within six hours after surgery. Results: Sixty patients (mean age: 4.5 years, range 3–6) underwent tonsillectomy for obstructive sleep apnoea. There were 22 females (36.7%). All patients were ASA1 (low surgical risk), and 96.7% (58) received intraoperative dexamethasone. No immediate complications were observed. At six hours post-surgery, pain was classified as light in 49 patients (81.7%) and mild in 11 (18.3%). Pain management included intravenous Paracetamol and niflumic acid suppository. Most patients (93.3%) resumed eating within six hours. Additionally, 90% (54) lived within an hour of the hospital, with responsible caregivers available. Parental satisfaction was high, with 78.3% (47) supporting same-day discharge, though 21.7% (13) had concerns about home monitoring. Conclusion: This study confirms that tonsillectomy can be safely performed in a day care setting in Sub-Saharan Africa for well-selected patients. Key eligibility factors include age, absence of comorbidities, and post-operative care capacity. Expanding ambulatory tonsillectomy in resource-limited settings could enhance healthcare efficiency and reduce costs. Keywords: Tonsillectomy, ambulatory surgery, eligibility criteria, Sub-Saharan Africa, post-operative outcomes, day care surgery.

Tonsillectomy is a commonly performed surgical procedure in pediatric patients for recurrent tonsillitis and obstructive sleep apnea. Despite its effectiveness, postoperative complications can impact recovery and patient outcomes. Identifying the frequency and nature of these complications can aid in optimising perioperative management and reducing morbidity. Objective: This study aimed to determine the frequency of complications following pediatric tonsillectomy. Methodology: A descriptive case series was conducted at the Department of ENT, Divisional Headquarter Teaching Hospital Kohat. One hundred thirty-one pediatric patients aged 1 to 12 years who underwent tonsillectomy were included through non-probability consecutive sampling. Patients with hematological disorders, congenital anomalies, or those undergoing adenotonsillectomy were excluded. Ethical approval was obtained, and informed consent was secured from guardians. Tonsillectomy was performed using extracapsular dissection and bipolar electrocautery techniques, with postoperative follow-up on the 1st, 7th, and 15th days. Complications, including hemorrhage, respiratory distress, infection, pain, and nausea, were recorded. Results: The mean age was 6.15 ± 3.63 years, with 54.2% males. Hemorrhage occurred in 3.8% of cases. Respiratory complications affected 7.6% of children. Infection was seen in 9.2% of children. Pain was recorded in 4.6% of children. Nausea was the most frequent complication, occurring in 14.5% of children. Conclusion: Post-tonsillectomy complications vary with age. Hemorrhage (3.8%) is more frequent in older children, while respiratory complications (7.6%) affect younger ones. Infection (9.2%) is linked to shorter symptom duration, pain (4.6%) is more common in females, and nausea (14.5%) is the most frequent complication. These findings emphasise the need for enhanced postoperative monitoring and individualised management strategies to reduce morbidity.

To systematically review the literature for articles evaluating outcomes of drug-induced sleep endoscopy (DISE) directed tongue surgery in children with prior adenotonsillectomy and persistent or recurrent obstructive sleep apnea (OSA), and to perform a meta-analysis on the polysomnographic (PSG) data. Systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines. Primary, post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT); Secondary, surgical response rate. Seven studies (283 patients) met criteria and reported PSG outcome data for the systematic review. The mean ± standard deviation surgical response rate was 70.0% ± 17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients) reported specific pre- and post-operative PSG data included in our meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1 to 4.2 ± 6.9 events/h (p < 0.04) with a mean difference (MD) of -5.13 [95% CI -7.13, -3.13], Z-score 5.02 (p < 0.00001). LSAT improved from 87.8 ± 5.7 to 90.1% ± 5.1% (p < 0.02) with a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (p < 0.0001). Existing literature demonstrates DISE-directed tongue surgery in children with persistent OSA can reduce AHI by approximately 50%, improve LSAT by nearly 3%, and have an overall positive response to surgery rate of 70%. There is collective evidence that DISE-directed tongue surgery is effective; limitations include heterogeneity in reported outcomes influenced by confounding factors.

One of the most frequent surgical operations on children in Australasia is tonsillectomy. For a non-surgical audience, this study attempts to give a current evaluation of the procedure's indications (and the evidence basis for each of these indications), together with a discussion of the surgical technique, perioperative care, and risks. Recurrent pharyngotonsillitis and obstructive sleep apnea (OSA) are the main causes of tonsillectomy; tonsillectomy is typically done in combination with adenoidectomy for both conditions. Tonsillectomy has been shown to enhance quality of life, child behavior, and objective measurements of OSA in sleep studies. It is less clear how surgery affects cognitive function. Highlights: Common pediatric surgery: Tonsillectomy for recurrent pharyngotonsillitis &amp; obstructive sleep apnea. Benefits: Improves quality of life, behavior, and OSA measurements. Uncertainty: Cognitive effects of surgery remain unclear. Keywords: Tonsillectomy, Children, Review

To investigate the efficacy and safety of exchange transfusion in neonates with severe pertussis. A retrospective analysis was performed for the medical data of five neonates with severe pertussis who underwent exchange transfusion in the Department of Neonatology, Hunan Children's Hospital, from August 2019 to March 2024. The clinical characteristics of the patients were summarized, and the efficacy and adverse reactions of exchange transfusion were analyzed. All five neonates had the symptoms of hypoxemia, recurrent apnea, and heart failure and required invasive mechanical ventilation. Two cases of pulmonary hypertension were observed, one of which was complicated by decompensated shock. Before exchange transfusion, the five children had a median leukocyte count of 82.60×109/L, a median absolute lymphocyte count of 28.20×109/L, and a median absolute neutrophil count of 43.10×109/L, and reexamination at 4 hours after exchange transfusion showed that these values decreased to 28.40×109/L, 7.60×109/L, and 15.40×109/L, respectively. The four children who underwent exchange transfusion in the early stage of cardiopulmonary failure showed varying degrees of improvement in oxygenation and a reduction in the partial pressure of carbon dioxide, and they were discharged after improvement; the one child who underwent exchange transfusion in the late stage of cardiopulmonary failure ultimately died. No child experienced severe adverse reactions related to exchange transfusion. For neonates with severe pertussis, initiating exchange transfusion in the early stages of cardiopulmonary failure can effectively reduce leukocyte levels, potentially improve survival rates, and is relatively safe.

ObjectiveObstructive sleep apnea syndrome (OSAS) is associated with recurrent apnea episodes. Positive airway pressure (PAP) treatment prevents repeatedly hypoxia in OSAS. Serum nitric oxide (NO) and Nod-like receptor protein 3 (NLRP3), that are involved in inflammation and pyroptotic cell death, may be affected hypoxia in OSAS. If so preventing hypoxia-ischemia episodes by PAP treatment may change serum NLRP3 and NO levels in OSAS. We aimed to determine whether serum levels of NLRP3 and NO change after at least 3 months of treatment with PAP.MethodsTwenty-five OSAS patients, including 17 men and 8 women, who underwent polysomnography (PSG) and had an apnea-hypopnea index (AHI) of 30 or more and had started treatment at PAP. AHI was recorded. Serum levels NO and NLRP3 were analyzed before and at least 3 months after PAP treatment.ResultsAfter treatment with the PAP device, serum NO levels were significantly increased, NLRP3 levels were significantly decreased compared to pre-treatment levels (p < 0.001, p = 0.003). No correlation was found between serum NLRP3 and NO levels, AHI, type of the PAP device before or after PAP treatment.ConclusionWe revealed that PAP treatment which prevents hypoxia, can alter the serum levels of NO and NLRP3 in OSAS, that is not related to the severity of AHI or type of the PAP device. This is the first study to measure NLRP3 levels before and after treatment with PAP in OSAS patients. Prospective studies with large cohorts and longitudinal follow-up evaluation of complications may provide further insights.

A resurgence of pertussis has been reported in numerous countries. This study aimed to determine the incidence, clinical characteristics, and outcome of pertussis among infants in Sarawak, Malaysia. We conducted a descriptive retrospective study of infants aged < 12 months with laboratory-confirmed pertussis admitted to Bintulu Hospital in Sarawak, Malaysian Borneo, from 2015 until 2021. Pertussis was confirmed in all patients using a polymerase chain reaction of nasopharyngeal aspirates. Of 588 infants who had a nasopharyngeal aspirate, 108 (18%) had laboratory-confirmed pertussis. The average annual incidence was 482 per 100,000 infants aged < 12 months between 2015 and 2019, with a marked decline in 2020 and 2021. Eighty-two (76%) were < 3 months of age. Seventy-eight (72%) were unvaccinated for pertussis, including 75 (96%) who were too young to receive the first dose. A third of the cases had atypical presentations. Severe disease characterized by hypoxemia, pulmonary hypertension, recurrent apnea, encephalopathy, or cardiovascular dysfunction occurred in 32%. Forty-eight percent required humidified high-flow nasal cannula oxygen therapy and 22% required invasive ventilation. Twenty-four percent overall needed intensive care. One (1%) infant had a fatal outcome. Nearly all cases of severe disease or those that required invasive ventilation or intensive care had received ≤ 1 dose of pertussis vaccination. A high incidence of pertussis with a high rate of severe disease was observed in Sarawak, Malaysia, predominantly among infants too young to be vaccinated. Additional vaccination strategies such as maternal vaccination or cocooning should be considered.

Babies with low birth weight is a condition where a baby is born with a weight of less than 2,500 grams. Such babies face a higher risk of mortality compared to those born with normal weight due to the immaturity of their organ systems, including the lungs, kidneys, heart, immune system, and digestive system. Babies with low birth weight often struggle to adapt to their environment, leading to instability in physiological functions such as temperature, heart rate, and oxygen saturation. This can result in hypothermia, increased heart rate, decreased respiratory frequency, recurrent apnea, and reduced SpO2 levels. This study aims to describe the nursing care provided to By.Ny.D, a patient with a medical diagnosis of babies with low birth weight in the Perinatology Room at Waled Hospital, Cirebon Regency. A qualitative research design with a case study approach was employed. The subject of the case study was By.Ny.D, observed over three days from January 22nd—24th, 2024. The primary nursing issues identified were ineffective breathing patterns and nutritional deficits. After three days of nursing care, the study concluded that the problems of ineffective breathing patterns and nutritional deficits remained unresolved, necessitating the continuation of the planned interventions.

Abstract Objectives: To study the epidemiological and demographic data of retinopathy of prematurity (ROP) as well as the effectiveness of intravitreal injection of bevacizumab (IVB) as monotherapy for type I ROP in a local neonatal intensive care unit in Egypt. Methods: An observational study, where the medical records of all babies eligible for ROP screening over a period of 12 months (2020–2021) were reviewed. The screening results were reported in stage, zone, extent, and plus disease. Babies with type 1 ROP were eligible for treatment with IVB. Their medical files were reviewed for possible risk factors associated with ROP. The primary outcomes were the presence or absence of ROP, eligibility for IVB, complications of IVB and regression or recurrence of ROP. Results: ROP affects a significant proportion of babies (55%). The lower the birth weight (and accordingly, the gestational age [GA]), the higher the incidence of ROP. Recurrent apnea, mechanical ventilation, and continuous positive airway pressure were associated with a significant risk for ROP. On the other hand, nasal cannula, sepsis, and blood transfusion did not significantly increase the risk of ROP. Although common, most cases (48.6%) had type 2 ROP and only required follow-up. IVB was effective and safe in arresting disease progression in 93% of the remaining patients with type 1 ROP (6.4%). Conclusion: ROP is a significant cause of morbidity in preterm babies in Egypt. Low birth weight, apnea, and respiratory support are significant risk factors. Most cases are mild and only require follow-up. Up to 6.4% of the cases had type 1 ROP. Monotherapy with IVB appears to be effective and safe. Neonatal care has to be optimized to further reduce the current incidence rate of ROP.

Obstructive sleep apnea syndrome (OSAS) causes recurrent apnea and intermittent hypoxia at night, leading to several complications such as cognitive dysfunction. However, the molecular mechanisms underlying cognitive dysfunction in OSAS are unclear, and oxidative stress mediated by intermittent hypoxia is an important mechanism. In addition, the improvement of cognitive dysfunction in patients with OSAS varies by different treatment regimens; among them, continuous positive airway pressure therapy (CPAP) is mostly recognized for improving cognitive dysfunction. In this review, we discuss the potential mechanisms of oxidative stress in OSAS, the common factors of affecting oxidative stress and the Links between oxidative stress and inflammation in OSAS, focusing on the potential links between oxidative stress and cognitive dysfunction in OSAS and the potential therapies for neurocognitive dysfunction in patients with OSAS mediated by oxidative stress. Therefore, further analysis on the relationship between oxidative stress and cognitive dysfunction in patients with OSAS will help to clarify the etiology and discover new treatment options, which will be of great significance for early clinical intervention.

Obstructive sleep apneas (OSA) are a breathing disorder characterized by recurrent apneas and hypopneas associated with complete or partial obstruction of the upper airways during sleep, resulting in disturbed sleep architecture, repeated hypoxemia and awakenings, and daytime sleepiness. OSA syndrome affects up to 34% of men and 17% of women in Western countries. Abnormalities in upper airway anatomy (frequently due to obesity), muscle tone, or neural control of breathing are the main causes. OSA is associated with impaired cognitive function and favors the onset of hypertension, being a major determinant of resistant hypertension, and may favor cardiovascular diseases (e.g., coronary artery disease and heart failure), thereby increasing mortality. Polysomnography and (cardio)-respiratory portable systems are used to diagnose and determine the severity of OSA. Management of OSA includes lifestyle modifications, such as weight loss and avoidance of supine sleep position, and continuous positive airway pressure. Mandibular advancement devices and upper airway surgery may also be appropriate for some patients. Hypoglossal nerve stimulation and pharmacological interventions are currently investigated to improve symptoms and outcomes.