Background: Myelomeningocele is a lifelong condition that features several comorbidities, such as hydrocephalus, scoliosis, club foot, and lower limb sensory and motor disabilities. Its management has progressed over time, ranging from supportive care to early postnatal closure to prenatal closure of the defect. Recent research discovered that fetal myelomeningocele closure (fMMC) provided superior neurological outcomes to those of postnatal closure. When performed at 12 months of age, fMMC can avert or delay the need for a ventriculoperitoneal shunt and reversed the hindbrain herniation. Moreover, fMMC reportedly enhanced motor function and mental development at 30 months of age. However, its long-term outcomes remain dubious.Purpose: This systematic review aimed to determine the long-term neurological cognitive, behavioral, functional, and quality of life (QOL) outcomes after fMMC. Methods:The PubMed, Directory of Open Access Journals, EBSCO, and Cochrane databases were extensively searched for articles published in 2007-2022. Meta-analyses, clinical trials, and randomized controlled trials with at least 5 years of follow-up were given priority.Results: A total of 11 studies were included. Most studies revealed enhanced long-term cognitive, behavioral, functional, and QOL outcomes after fMMC. Conclusion:Our results suggest that fMMC substantially enhanced patients' long-term neurological cognitive, behavioral, functional, and QOL outcomes.
Background: Restorative options in medically refractory epilepsy are restricted to ablative brain surgery, the trial of antiepileptic medications, or palliative procedures. Vagal nerve stimulation (VNS) is an accessible palliative method of which the mechanism of action isn't well understood, yet with set up adequacy for medically refractory epilepsy and low occurrence of incidental effects. Objectives: This systematic review aimed to evaluate the action of epilepsy treatment options. Methods: We searched for relevant studies published in 2016-2021 with PRISMA charts. For English published statistical analyses, we include all studies conducted on pediatric epileptic patients who have undergone epilepsy surgery and VNS. Results: Antiepileptic impacts of VNS incorporate expanded movement of the locus coeruleus (LC) neurons with a raised norepinephrine (NE) discharge in the hippocampus, cortex, and amygdala. VNS-modulatory consequences for other synapse frameworks such as cholinergic, GABAergic, and glutamatergic depend on the activation of the LC-NE pathway. While in pediatric epilepsy, early surgical intervention is frequently recommended to work on cognitive and behavioral outcomes that unequivocally portray the epileptogenic zone. Conclusion: The general rate of complication caused by epilepsy surgery was sensibly low (5%), suggesting that epilepsy medical procedures, particularly primarily temporal lobe resection, can be safe preferably with recent procedure options, while VNS could be more effective as therapy begins at early stages pre- or post-seizure onset to decide the preventative role of VNS in human epileptogenesis when the treatment is given promptly.
Language development is one of the most important developments in children, influenced by internal and external factors. One of the most influential external factors is verbal environment. Specific language disorder can occur in one language in children with bilingual environment in the first three years of life. A cross sectional study to assess relationship between bilingual environment and Indonesian language development in children was conducted in early childhood education programs in Medan, Indonesia from November 2017 to March 2018. All sample were recruited with consecutive sampling method. Physical and hearing examination were performed. Language development were examined with Cognitive Adaptive Test/ Clinical Linguistic Auditory Milestone Scale (CAT/CLAMS). Fisher's exact test was used to assess relationship between bilingual environment and Indonesian language development. There was 9.1% children with Indonesia language development disorder in bilingual group, whereas none in non bilingual group. There was significant relationship between bilingual environment and Indonesian language development in children.
Introduction: Vitamin K deficiency bleeding (VKDB) is a term that describes the condition of hemorrhagic disorders in newborns. Late-onset VKDB occurs between the second week and sixth month of life. Intracranial hemorrhage often occurs in cases of late-onset VKDB and can cause 14-20% mortality and 40% long-term neurological morbidity, so it is important to treat patients until they are stable, especially with limited health facilities. Case Report: A baby boy aged 1 month 8 days was brought by his parents to RSUD Deli Serdang Lubuk Pakam with the chief complaint of an enlarged stomach, accompanied by paleness, weakness, convulsions, and altered consciousness. A midwife assisted the delivery with unknown history of immediate vitamin K injection after birth. We diagnosed the patient with VKDB according to the clinical symptoms. The head CT scan showed subdural and subarachnoid hemorrhage with cerebral edema. We transfused the patient with Packed Red Cells and Fresh Frozen Plasma 20 cc/12 hours 5 times, administered Vitamin K injection 3 mg/IM for 3 days, and other supportive therapy. The patient's condition improved within the third day of hospitalization with recovered consciousness and was transferred to the referral hospital. Discussion: The key feature of late-onset VKDB is the incidence of ICH in 30-88% of patients, leading to a high incidence of mortality. This study highlights the importance of prompt, and early treatment of VKDB with proper history taking, clinical examination, and relevant investigations to reduce morbidity and mortality. Conclusion: In conclusion, secondary late-onset PDVC is more common than the primary subtype, and late-onset PDVC is still an important cause of morbidity and mortality in developing countries including Indonesia, where vitamin K prophylaxis is not routinely performed
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