Background: Acute appendicitis in a newborn is rare and may be fatal. The reported incidence is 0,04 % to 0,2 %. Diagnosis remains challenging as the symptoms are undefined.Case presentation: Here we present a full-term newborn boy of 9 days presenting with malaise, reluctance to feed and subfebrile fever. Over the course of 6 days his condition became worse. The newborn was febrile, passed no stool and his stomach became distended. Perforation due to necrotizing enterocolitis was highly suspected. The diagnosis of acute appendicitis was finalized perioperatively after the perforation and worsening condition made the emergency surgery inevitable. After 16 days of admission the patient was discharged in good condition.Conclusion: Appendicitis in neonates is a dangerous yet manageable condition. While rare it should be included in differential diagnosis when presented with atypical necrotizing enterocolitis or unexplained peritonitis. Quick and accurate diagnosis may increase survival rates.

Cryptorchidism is a common disorder in boys that has been widely studied both experimentally and clinically. The role of the gubernaculum, a mesenchymal tissue extending from the fetal testis and epididymis to the developing scrotum, is still unclear. Even the name is debated: ‘gubernaculum epididymis’ or ‘gubernaculum testis’. This review does not aim to provide a global overview of competing theories on testicular descent, but focuses on the role of the gubernaculum in epididymo-testicular descent. We identified four major pitfalls of gubernaculum research: the role of the gubernaculum, of insulin-like peptide 3, anti-Müllerian hormone, and androgens. The major critical issues were that the gubernaculum plays a guiding role for the epididymis, descending prior to the testis and expanding the inguinal canal; insulin-like peptide 3 is not as important for the process of descent in humans as the rate of insulin-like peptide 3 mutations is low; anti-Müllerian hormone plays no significant role in epididymo-testicular descent; androgens and gonadotropins play a crucial role in epididymo-testicular descent. The role of the epididymis in the complex process of gubernaculum, epididymis, and testis migration is underestimated and should be included in future research.

The global prevalence of arterial hypertension (AH) in the pediatric population is increasing, but therapeutic approaches and the choice of the most suitable antihypertensive medications remains challenging. The study aimed to estimate the prevalence, treatment rates, and pharmacological treatment patterns of children and adolescents with AH in Lithuania during 2019 using real-world data. The study population consisted of citizens of Lithuania aged 0 to 17 years, who were diagnosed with AH according to the International Classification of Diseases (ICD). The analysis of reimbursed antihypertensive medication prescriptions was performed according to AH etiology and age. The overall prevalence of AH by diagnostic ICD codes in 2019 was 0.29%:0.24% for primary and 0.05% for secondary. Treatment rates were 39.8% for primary AH and 66.3% for secondary AH. Angiotensin-converting enzyme inhibitors (ACEi) were the most popular medications irrespective of the etiology of AH or age. Beta-blockers were in the second place and used more often in older children. Calcium channel blockers were the third and angiotensin receptor blockers were the fourth most frequent choices. Enalapril was the most popular agent in the ACEi group and metoprolol in the beta-blocker group. Nearly forty percent of Lithuanian children with primary AH receive pharmacological therapy compared to two-thirds with secondary AH. Although ACEi are the predominant class of antihypertensive medications, discordances with available guidelines are evident, particularly in the overuse of beta-blockers and underuse of diuretics.

Tobulėjant širdies ydų gydymo metodams, daugėja moterų sulaukusių reprodukcinio amžiaus, kurioms reikalinga pagalba planuojant nėštumą ir prižiūrint nėštumo eigą. Rizika nėštumui su L-stambiųjų kraujagyslių transpozicija priklauso nuo pacientės funkcinio pajėgumo, sisteminio skilvelio funkcijos, aritmijų ir kitų gretutinių ydų. Nėštumas paankstina sisteminio skilvelio funkcijos sutrikimą ir moterys, kurių sisteminio dešiniojo skilvelio išstūmio frakcija mažiau 40 proc., turėtų nuo jo susilaikyti. Motinų, kurioms diagnozuota L-stambiųjų kraujagyslių transpozicija, vaikai 2–3 kartus dažniau patiria perinatalines komplikacijas. Nepaisant to, sėkmingas nėštumas yra galimas. Pacientėms su įgimtomis širdies ydomis iki nėštumo turėtų būti atliktas nėštumo planavimas.