DESCRIPTIONA 34+4 weeks neonate was born by spontaneous vaginal delivery with normal antenatal scans. Routine neonatal examination revealed the absence of a vaginal opening with bulging of vaginal introitus (figure 1). Urethral and anal openings were patent. A provisional diagnosis of an imperforate hymen with hydrocolpos was considered.Subsequent investigations revealed a deranged renal function at 22 hours of life (creatinine 99 mmol/L, urea 10.2 mmol/L, K 6.6 mmol/L and Na 132 mmol/L). An urgent abdominal ultrasound was arranged to rule out hydronephrosis. The kidneys and lower genitourinary tract were normal.The imperforate hymen was managed surgically through a hymenal incision. Subsequently, the external female genitalia appeared normal (figure 2) and the renal function normalised. A positive family history was noted with an elder sibling who also had an imperforate hymen, which was surgically treated at 5 months.The incidence of imperforate hymen is estimated at 0.014-0.1% and presentation is often late with amenorrhea in adolescence. Hydrocolpos is cystic dilation of the vagina with fluid accumulation due to stimulation of secretory glands of the reproductive tract secondary to vaginal obstruction. Hydrocolpos may lead to obstructive uropathy through the compression of the lower urinary tract, resulting in hydronephrosis and hydroureters. 1Hence early detection is essential as it could be associated with life-threatening renal failure.2 As observed in our report, cases of familial recurrence have been reported. 3A thorough newborn examination is essential to screen for an imperforate hymen, which can result in renal complications in the neonatal period. Learning points▸ A thorough newborn screening examination may enable the detection of rare conditions such as imperforate hymen presenting in the neonatal period. ▸ An imperforate hymen usually presents in adolescence with amenorrhoea, but may be detected in the neonatal period. ▸ Hydrocolpos associated with an imperforate hymen can cause renal failure.Contributors MR and CB conceived the idea. LP wrote the first draft of the article. MR and CB participated in revising the manuscript and all authors approved the final submitted version.Competing interests None declared. Patient consent Obtained.Provenance and peer review Not commissioned; externally peer reviewed. Figure 1 Imperforate hymen noted at birth.
MANETs consists of mobile nodes that dynamically form a network temporarily without any support of central administration. MANET is a self organized and self configurable network. Moreover, each node in MANET moves arbitrarily, making routing a crucial issue. This paper presents the performance evaluation of Dynamic Source Routing (DSR) and Destination-Sequenced Distance Vector (DSDV) routing protocols based on metrics such as throughput, packet delivery fraction, dropped packets, packet loss, normalized routing load and average end-to-end delay by using the NS2 simulator. DSDV is a Proactive routing algorithm where the mobile node periodically broadcasts an advertisement message which is transmitted after expiration of the timer. DSR is a Reactive routing algorithm where a mobile node of MANET connects or advertises the message only when it is needed.
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