BackgroundCongenital heart diseases are the most common type of congenital defects, and account for more deaths in the first year of life than any other condition, when infectious etiologies are ruled out.ObjectivesTo evaluate survival, and to identify risk factors in deaths in newborns with critical and/or complex congenital heart disease in the neonatal period.MethodsA cohort study, nested to a randomized case-control, was performed, considering the Confidence Interval of 95% (95% CI) and significance level of 5%, paired by gender of the newborn and maternal age. Case-finding, interviews, medical record analysis, clinical evaluation of pulse oximetry (heart test) and Doppler echocardiogram were performed, as well as survival analysis, and identification of death-related risk factors.ResultsThe risk factors found were newborns younger than 37 weeks (Relative Risk - RR: 2.89; 95% CI [1.49-5.56]; p = 0.0015), weight of less than 2,500 grams (RR: 2.33 [; 95% CI 1.26-4.29]; p = 0.0068), occurrence of twinning (RR: 11.96 [95% CI 1.43-99.85]; p = 0.022) and presence of comorbidity (RR: 2.27 [95% CI 1.58-3.26]; p < 0.0001). The incidence rate of mortality from congenital heart disease was 81 cases per 100,000 live births. The lethality attributed to critical congenital heart diseases was 64.7%, with proportional mortality of 12.0%. The survival rate at 28 days of life decreased by almost 70% in newborns with congenital heart disease. The main cause of death was cardiogenic shock.ConclusionPreterm infants with low birth weight and comorbidities presented a higher risk of mortality related to congenital heart diseases. This cohort was extinguished very quickly, signaling the need for greater investment in assistance technology in populations with this profile.

Summary Background:  It is controversial whether CARD15 variants are truly associated with a more severe form of Crohn's disease. The relative role of CARD15 genotype and smoking in Crohn's disease progression is also debated. Aim:  To investigate the association between CARD15 variants and history of resective surgery in patients with Crohn's ileal disease, taking into account smoking as a possible confounding factor. Methods:  We originally assessed CARD15 genotype in 239 north Italian Crohn's disease patients (mean follow‐up: 10.1 ± 8.1 years). We then focused on 193 patients with proven ileal involvement, 70 of whom (36.3%) carried CARD15‐mutated alleles (G908R, R702W, L1007fs). Results:  Carriage of CARD15 variants was positively associated with family history and ileal‐only disease and negatively associated with uncomplicated behaviour at maximal follow‐up (P < 0.05). Ileal resection was the only variable independently associated with CARD15 variants at multivariate analysis (OR 3.8; 95% CI 1.6–9.2; P = 0.003). Kaplan–Meier analysis showed that ileal resection was favoured both by CARD15 variant‐carriage (P = 0.01) and by smoking (P = 0.05), but smoking did not affect progression to surgery in variant carriers (P = 0.31). Thirteen of 14 (93%) patients being resection‐free at 15‐year follow‐up, had CARD15 wild‐type genotype (P = 0.01), whereas only seven (50%) had never smoked (P = 1.0). Conclusions:  In summary, CARD15 variant‐associated Crohn's ileitis is virtually committed to stricturing and/or penetrating disease and, eventually, to resective surgery. Smoking accelerates progression to surgery in patients with wild‐type CARD15 genotype, but it seems to exert no additional effect in CARD15‐variant carriers.

No abstract

This is a case report of a rare airway Foreign Body (FB), the first reported case of an extruded prosthesis of previous cervical spine arthrodesis still attached to the wall of the hypopharynx, obstructing the airway, and requiring immediate removal. A 56-year-old man with a history of previous cervical arthrodesis (C3-C7). He presented anterior displacement of the Cage Device and erosion of the posterior wall of the hypopharynx, with the prosthesis causing partial obstruction of the larynx. After the Neurosurgery and Radiology team determined that there were no risks of cervical spine instability, we were able to remove the device in the operating room using Laryngoscope and McGill forceps with success. After proper evaluation of the case, we were able to remove the foreign body uneventfully. Given the rarity of this complication, we hope this case report can assist in the treatment and management of future cases.