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Biomedical subjects

B A Paes

Publications and source records attributed to B A Paes.

At least 19 recordsLinked to original sources
PubMed2003

Current strategies in the prevention of respiratory syncytial virus disease.

Infants infected with respiratory syncytial virus (RSV) develop both upper and lower respiratory tract infections resulting in laryngotracheobronchitis, bronchiolitis and pneumonia. Premature infants of less than 32 weeks' gestation and those with underlying chronic lung disease are particularly susceptible and incur significant morbidity and mortality following hospitalisation. Conservative RSV prevention strategies focus on the interruption of transmission by proper hand-washing techniques and reducing exposure to potential environmental risk factors. Major challenges have impeded the development of an RSV vaccine but a licensed product may be expected in the near future. Prophylaxis with a humanised mouse monoclonal antibody (palivizumab) has been effective in reducing the rate of RSV hospitalisation in high-risk premature infants in phase II-IV trials and is available for use within internationally approved guidelines. Experimental studies evaluating the use of palivizumab in patients with congenital heart disease, those with cystic fibrosis and immunosuppressed bone marrow transplant recipients are well underway, the results of which are eagerly awaited.

Antibodies, Monoclonal↗
PubMed2002

Late-onset left diaphragmatic hernia after group B streptococcal sepsis: An unusual presentation.

There are several reported cases of late presentations of right diaphragmatic hernia with early- as well as late-onset group B streptococcal (GBS) infections. The authors describe the first case of late-onset left diaphragmatic hernia with late onset GBS infection in a preterm infant. The diagnosis was prompted by a dramatic clinical deterioration during the recovery phase of GBS sepsis.

Hernia, Diaphragmatic↗
PubMed2001

Ovarian cyst in a premature infant treated with spironolactone.

We describe the late occurrence of an ovarian cyst in a premature infant, the second of a set of monochorionic diamnionic twins, during treatment with spironolactone. Spironolactone is commonly used in the management of neonatal chronic lung disease in combination with other diuretics because of its potassium-sparing effect. It has progestational activity and has been reported to cause gynecomastia. It is used widely for its antiandrogenic properties in the treatment of female hirsutism and hyperandrogenism and it has a role in the management of familial male-limited precocious puberty. However, the estrogenic influence induced during therapy may significantly alter the hormonal milieu in newborn females, resulting in the formation of ovarian cysts. Simple ovarian lesions <5 cm merit close ultrasonographic surveillance for resolution while larger complex masses may warrant surgical intervention.

Diseases in Twins↗
PubMed1995

Discordant fibular aplasia in twins.

A male infant, one of monozygotic twins, was born with absence of fibulae, ectrodactyly of the right hand and both feet, with accompanying deficiencies. This second case report of a discordant fibular aplasia developmental field defect occurring in monozygotic twins, although likely sporadic, is interesting because of the similar pattern of anomalies.

Abnormalities, Multiple↗
PubMed1995

Group B streptococcus. Is it time for a screening program?

Group B streptococcal infection often causes perinatal sepsis. Early diagnosis is based on a high index of suspicion and laboratory tests. Proposed interventions targeted at the antepartum, intrapartum, and postpartum periods have met with limited success. Screening has not been widely adopted.

Adult↗
PubMed1994

Changing physicians' behavior using combined strategies and an evidence-based protocol.

OBJECTIVES: To review the number of superficial cultures performed in the evaluation of neonatal sepsis and to validate physicians' compliance with an established protocol. DESIGN: Before-and-after-comparison using medical audit. SETTING: Intensive care nursery in a secondary level perinatal facility. PARTICIPANTS: One hundred seventy-five consecutive newborns admitted during a 6-month period for the assessment and potential treatment of sepsis. Eligible patients met the entrance criteria of having a superficial culture performed in conjunction with at least one deep culture, which included cerebrospinal fluid, blood, or urine. This cohort was compared with 205 patients before the introduction of the protocol. INTERVENTIONS: A second audit of physician practice 9 months following the introduction of an evidence-based hospital protocol to discontinue the use of superficial cultures in the diagnostic assessment of neonatal infection. Evidence-based medicine, an opinion leader, continuing medical education rounds, immediate feedback through direct encounters with physicians, and barriers in accessing microbiological tests were used to alter physician behavior. MEASUREMENTS/RESULTS: A significant reduction from 50.5% to 6.9% was achieved in the proportion of superficial cultures performed and a substantial cost savings of $4454.84 was realized without incurring patient morbidity. CONCLUSIONS: A methodologically rigorous reaudit process with planned, interventional strategies may be used as part of a continuous quality improvement program to affect change in physicians' practices. Existing hospital practice standards should be reevaluated against emerging scientific evidence.

Clinical Protocols↗
PubMed1993

Congenital hypothyroidism: diagnosis and management.

Every newborn infant should be screened for congenital hypothyroidism before discharge from the nursery. Neonatal screening for hypothyroidism was introduced to North America in 1972 and has been demonstrated to be cost effective in the prevention of neurological damage in children. Interpretation of diagnostic test results from such programs is based on understanding the physiology of the thyroid gland and recognition that neonatal hypothyroidism primarily stems from an embryological disorder of thyroid development rather than central causes involving the hypothalamic-pituitary axis. Early diagnosis of hypothyroidism is dependent on proper timing and collection of blood samples and an efficient screening program reporting accurate results. A thorough maternal and family history in conjunction with clinical signs and symptoms of hypothyroidism, biochemical tests, and radiological findings should be used to rapidly establish the diagnosis. Early detection and treatment with thyroxine normalizes skeletal maturation, physical growth, cognitive functioning, and motor development of affected newborns. Nurses play an important role in identification, management, and supportive care of infants with hypothyroidism so that maximal potential is achieved.

Clinical Protocols↗
PubMed1992

Cloacal exstrophy: prenatal diagnosis before rupture of the cloacal membrane.

Embryologically, cloacal exstrophy is thought to result from persistence and subsequent rupture of the infraumbilical cloacal membrane during the fifth embryonic week. We report a case of cloacal exstrophy in which a prenatal diagnosis was made prior to rupture of the cloacal membrane. A routine ultrasound at 17 weeks' gestation demonstrated monoamniotic twins. One twin was normal, but the other was found to have a sacral myelomeningocele, "rocker-bottom" feet, splaying of the pubic rami, and a large cystic mass protruding from the infraumbilical anterior abdominal wall. A repeat ultrasound was performed at 22 weeks, with the same findings. At 26 weeks, further examination showed disappearance of the abdominal cyst, a small omphalocele, no demonstrable bladder, and the suggestion of prolapsed bowel inferior to the umbilical cord insertion. After delivery at 34 weeks, the abnormal twin was found to have the typical findings of cloacal exstrophy, myelomeningocele, bilateral lower limb anomalies, and extremely foreshortened small bowel. Rupture of the presumed cloacal membrane after 22 weeks in this case is inconsistent with our current understanding of the embryology of this anomaly, and should stimulate a reexamination of the current concepts. If the characteristic features are recognized, cloacal exstrophy can be diagnosed by prenatal ultrasound, permitting prenatal counseling and appropriate perinatal management.

Abnormalities, Multiple↗
PubMed1992

Management of prenatally diagnosed tracheal obstruction: access to the airway in utero prior to delivery.

A fetus of 23-weeks gestation presented with polyhydramnios, and was found on sonography to have a large anterior cervical teratoma. At 26 weeks the mother went into premature labor and the membranes ruptured; at this time the uterus was of 32-weeks size secondary to polyhydramnios. A cesarean section was performed through a low transverse uterine incision, and the fetal head and shoulders were delivered with the cord intact. An endotracheal tube was placed, and the cord was then divided. The baby was taken to the neonatal intensive care unit for stabilization prior to planned resection, but suffered pharyngeal hemorrhage followed by endotracheal tube dislodgement several hours after birth, and expired. Despite an unfortunate outcome, this case illustrates the feasibility and potential value of in utero airway access in cases of prenatally diagnosed tracheal obstruction.

Adult↗
PubMed1991

Baller-Gerold syndrome associated with congenital hydrocephalus.

We present a new case of the Baller-Gerold syndrome (BGS) in an infant with prenatally apparent severe hydrocephalus, growth retardation, and cardiac and limb abnormalities detected by ultrasound at 26 weeks of gestational age. Subsequent survival to term and neonatal examination confirmed an unsuspected diagnosis of BGS.

Abnormalities, Multiple↗
PubMed1990

Subcutaneous fat necrosis with hypercalcemia.

We report the case of an infant with diffuse subcutaneous fat necrosis following birth asphyxia who had hypercalcemia and the rare complication of venous calcification. The clinical and radiologic findings resolved over 5 months. The disease is characterized by the presence of painless subcutaneous nodules, mainly over bony prominences, possibly associated with hypercalcemia and calcification. Early identification of hypercalcemia will avert its serious sequelae.

Calcinosis↗
PubMed1988

Birth asphyxia: does the Apgar score have diagnostic value?

The current literature was reviewed to evaluate the Apgar score as a diagnostic test for the presence of asphyxia. Several studies were examined and the sensitivity, specificity, and predictive values of the Apgar scores calculated. Using an umbilical cord arterial pH below 7.2 as evidence of asphyxia, the one-minute Apgar score showed poor sensitivity as a marker of asphyxia. Therefore, we discourage reference to the term "asphyxia" when Apgar scores alone are used as supportive evidence.

Apgar Score↗
PubMed1984

Fatal malformations of the larynx and upper trachea.

Five infants with a spectrum of rare malformations of the larynx and trachea are presented. All infants died because of problems with intubation and ventilation. The series reflects the wide variety and complexity of malformations that may co-exist, and successful management may require open tracheotomy.

Abnormalities, Multiple↗