Objective: Activation of the maternal immune (MIA) system while pregnant can have significant effects on fetal development. Here, the authors sought to examine MIA and its effects on fetal craniofacial formation. As a measure of MIA, data on maternal influenza infection was used, as influenza occurs in a predictive fashion, is not vertically transmitted, and is found to generate a robust maternal immune response. Thus, this study measures the association of the incidence of influenza infection in the United States with the incidence of craniofacial congenital deficits—specifically encephalocele and microtia. Methods: The National Inpatient Sample Database (NIS) was referenced to identify national estimates of infants born with each disease from 2004 to 2013. The gross monthly disease incidences were adjusted based on the number of newborns each month. The National Respiratory and Enteric Virus Surveillance System’s FluView database from the CDC was used to obtain influenza data from 2003 to 2013. Mixed effect logistic regression analyses were conducted to find the association between influenza occurrence and each disease, specifically an odds ratio (OR). Results: There were 2858 infants born with encephalocele and 3371 born with microtia from January 2004 to December 2013. Microtia showed no statistically significant correlation with influenza rates and served as a methodologic control. Encephalocele, however, showed a strong correlation with influenza infection specifically during the eighth month of pregnancy (OR = 34.538, 95% confidence interval: 3.815-312.681). Conclusion: This study shows a strong correlation between maternal influenza infection during the eighth month of pregnancy and encephalocele incidence. This suggests that there is an additional trigger for encephalocele development towards the end of the pregnancy not currently understood in the literature. Although there appears to be a connection between MIA and encephalocele formation, more research is needed to confirm this theory.
Introduction: Colonoscopes ca potentially become incarcerated in inguinal hernia sacs during routine colonoscopies. The entrapment of colonoscopes may occur when patients present with unknown inguinal hernias. Entrapment can occur during the insertion or withdrawal of the scope. We report a case of a screening colonoscopy resulting in entrapment of a colonoscope in a left inguinal hernia, which was managed by applying pressure to the hernia site. Case Description/Methods: AH is a 66-year-old, white male who presented to the ambulatory surgical center for a screening colonoscopy. During the procedure, the scope repeatedly ended up in the blind end. It was evident the patient had a left inguinal hernia, and the scope was entering the hernia sac (Figure). Subsequently, the endoscopist withdrew the scope to prevent scope entrapment in the hernia sac, while the assistant put pressure on the hernia site under the patient's gown to reduce the hernia sac. The colonoscopy was reattempted, while the assistant continued to push on the hernia site, and the procedure was completed without further difficulties. Discussion: There have been 2 previous case reports of scope entrapment in a patient's hernia sac resulting in the scope being removed using either surgery, fluoroscopy, or the pulley method. 1, 2 It is best to avoid performing a colonoscopy for patients with an irreducible hernia. For a reducible hernia, applying pressure on the hernia site may ensure that the scope does not enter the hernia sac. If a patient has an unknown hernia in an open-access colonoscopy, then the endoscopist may not be prepared for a hernia until they start the procedure. Gastroenterologists should be aware of the consequences of patients presenting with unknown inguinal hernias, especially if they are irreducible, to avoid potential complications and emergent operations. Physicians performing colonoscopies should be cognizant of the potential risk to patients with large, irreducible inguinal hernias. Larger studies are needed to definitively mandate this recommendation.
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