Category: Blog

World Pneumonia Day serves as an important reminder of the health challenges faced by our aging population. As our loved ones grow older, they become increasingly susceptible to dangerous respiratory infections like pneumonia. At Medeor, we see it as our duty as skilled medical professionals to educate and empower communities to protect their vulnerable seniors.

Pneumonia is an inflammation of the lungs typically caused by bacterial or viral infections. While it can affect people of any age, the risk increases significantly for elderly individuals. Changes to the immune system, underlying chronic conditions, and reduced lung function all contribute to the heightened vulnerability of aging adults to pneumonia.

Pneumonia can have serious consequences for seniors, often leading to extended hospital stays and impacting overall health. Recovery can be challenging, as pneumonia may worsen existing health conditions and leave lasting effects on respiratory function. For older adults, it’s essential to prioritize preventive measures and early treatment to minimize the risks associated with this illness.

Fortunately, there are steps we can take to protect our elders from this dangerous illness. Chief among them is ensuring that older adults receive the recommended pneumococcal and influenza vaccinations. These safe, effective immunizations can significantly reduce the risk of contracting potentially deadly strains of pneumonia. Additionally, promoting healthy habits like regular handwashing, avoiding contact with sick individuals, and not smoking can further strengthen respiratory defenses.

For seniors already affected by pneumonia, prompt treatment with antibiotics and respiratory support is crucial. At Medeor, our healthcare providers remain vigilant in screening for signs of infection and responding decisively. Families can also play a vital role by monitoring seniors for concerning symptoms and advocating for timely, appropriate care.

As we reflect on World Pneumonia Day, let us recommit ourselves at Medeor to protecting the health and well-being of aging populations. Through education, vaccination, and attentive medical care, we can safeguard our elders from the effects of this serious respiratory disease. In doing so, we honor the invaluable wisdom and life experiences they contribute to our communities.

We present the case of a 38-year-old female patient who visited the Plastic Surgery Clinic requesting breast reconstruction on the right side. The patient reported finding a lump in her right breast two months ago and opted for screening and mammography. She was initially evaluated by a breast surgeon, who performed additional tests and a mammogram. The lump was asymptomatic but had been growing in size over the past two months.

Encounter with the Surgeon

The patient was otherwise fit and had no prior medical or surgical history. She was a non-smoker with no significant family history of any cancer, including breast cancer. Her only history was a C-section performed for the birth of her only child 10 years ago.

On Examination: She was of normal weight and height with a BMI of 22. She has small breasts with grade 2 ptosis and wears a size 34C bra. There is a hard, non-mobile lump in the upper outer quadrant of the breast. The skin is free and easily pinchable, separate from the lump. The nipple-areola complex is normal with no discharge. The lump measures 2 x 3.5 cm and is non-painful. There are no palpable lymph nodes in the axilla or neck. The breast skin quality is moderate with minimal stretch marks. The patient lacks significant adipose tissue or loose skin on the abdomen. The left breast is symmetrical in shape, volume, and size, with no abnormalities.

First Assessment

Based on the mammography findings, a decision was made to perform a biopsy of the lump in the right breast. The biopsy result revealed ductal invasive carcinoma of the right breast. Further testing with PET and MRI scans showed no metastatic disease elsewhere in the body. The case was discussed in a multidisciplinary team (MDT) meeting with an oncologist, onco-surgeon, plastic surgeon, radiologist, pathologist, radiation oncologist, and other members present.

The Plan

Given the young age of the patient and the diagnosis of invasive ductal carcinoma with aggressive features, a decision was made for neoadjuvant chemotherapy followed by skin-sparing mastectomy with sentinel lymph node biopsy (SLNB) and immediate tissue expander placement for staged reconstruction. A backup plan of axillary lymph node dissection was prepared in case of a positive SLNB report on frozen section. The patient and her family were involved in the treatment planning and were thoroughly informed about the management options. The patient agreed to the treatment plan.

Evaluation before Surgery

Following a comprehensive assessment by the anesthesiology team, additional screening tests were performed, which were within normal limits. A port-a-cath was inserted in the left subclavian vein for chemotherapy under the supervision of a vascular surgeon. The patient completed the entire cycle of neoadjuvant chemotherapy without major issues. A full set of repeat screening and diagnostic tests was performed. The PET scan showed a significant decrease in the lump size, with no other lesions or metastasis. Surgery was planned for three weeks later.

First Surgery

A skin-sparing mastectomy was initiated by the oncosurgeon using a radial central incision on the breast, with excision of all breast tissue including the nipple-areola complex. SLNB using radioactive gamma camera and blue dye was performed. The first largest lymph node with blue staining was excised in the axilla. The frozen section report of the lymph node was negative, so complete axillary lymph node dissection was unnecessary. The frozen section also confirmed clear cancer margins in the mastectomy specimen, with no further excision needed. A 350 cc tissue expander was placed in a submuscular plane under the pectoralis major muscle. The lower half of the tissue expander was covered with the serratus anterior muscle fascia. The expander was initially inflated with 150 cc of normal saline. The skin was closed without tension in multiple layers over a silicone 15 French suction drain. The patient tolerated the surgery well and was moved to recovery in a stable, pain-free condition. The patient spent the following day in the hospital and was discharged home with a plan for regular follow-ups every 3 to 5 days until complete wound healing.

Radiation Treatment

Following wound healing, completed four weeks post-surgery, the patient underwent a full cycle of radiation therapy. She had an uneventful post-operative course and successfully completed radiation therapy, though there were significant skin changes and minor ulcerations on the right chest skin. The expander had a second-degree capsular contracture and had migrated superiorly on the right chest. The patient reported sensitivity, pain, and stiffness in the right chest and shoulder, attributed to radiation therapy. After eight weeks of conservative management with skin ointments and supportive therapy, the patient was scheduled for tissue expander expansion with the plastic surgeon. She visited weekly for six weeks to achieve regular saline expansion of the tissue expander. Once adequate size and volume of the tissue expander were reached, the breasts achieved good symmetry and volume. A decision was made to proceed with the next stage of reconstruction by replacing the tissue expander with a silicone implant. Surgery was planned two weeks later.

Second Surgery

A final set of pre-operative screening tests was performed, and fitness was confirmed by the anesthesiology team. The patient underwent the final reconstructive surgery led by Dr. Abizer Kapadia. During surgery, the tissue expander was removed. The pocket for the breast silicone implant was revised, and a 340 cc silicone implant, matching the left breast, was inserted in the same submuscular plane. The lower part of the implant was covered with acellular dermal matrix (ADM) mesh and sutured to the lower border of the pectoralis major muscle and the inframammary fold. The skin was closed without tension in multiple layers over a 15 French silicone drain. The patient tolerated the surgery well and was moved to recovery in stable, pain-free condition. The patient spent one night in the hospital and was discharged home in a healthy condition.

Post-Operative Care

The patient had an uneventful recovery. Regular dressing changes were performed until complete wound healing within three weeks. The patient achieved a successful outcome, with symmetry, volume, and size comparable to the left breast. She expressed satisfaction with the reconstructive result, with no complaints of pain, stiffness, or other issues following complete healing. After nine months of comprehensive care and treatment, she resumed a normal life with her family without further issues. She expressed gratitude to the entire team for her breast cancer and reconstruction treatment. The patient continued follow-ups every six months for two years to monitor the breast cancer and reconstruction status.

Conclusion

This case highlights the importance of holistic, compassionate, and comprehensive management of breast cancer in a young, healthy woman. The multidisciplinary team played a crucial role in the complete management of the patient, focusing on cancer removal and patient cure. This case also underscores the value of successful breast reconstruction. Breast reconstruction surgery empowers women, allowing them to lead normal lives without the stigma or loss associated with mastectomy. Reconstruction helps retain femininity and psychological well-being. Breast cancer cases should be managed with a holistic approach and a positive outlook on breast reconstruction.

Take-Home Points

1. Early screening and diagnosis of breast cancer should be a goal for every woman.
2. A professional multidisciplinary team (MDT) is essential for optimal care.
3. Breast cancer treatment and reconstruction go hand-in-hand and are equally important.
4. Breast reconstruction empowers women, preserving femininity and self-confidence, enabling them to live a healthy life without stigma.

Breast cancer is one of the most common types of cancer, affecting millions of people worldwide. Early detection is crucial because it significantly improves the chances of successful treatment and survival. While advanced medical screenings like mammograms play a key role in identifying cancer, self-awareness and routine self-examinations are also important in detecting abnormalities early on. Breast cancer screening involves a combination of these methods, and understanding its importance can save lives.

Early Detection Saves Lives

Breast cancer, like many other types of cancer, is more treatable in its early stages. When detected early, the cancer is usually confined to the breast, making it easier to treat. According to cancer statistics, the five-year survival rate for localized breast cancer (stage 1) can be as high as 99%. This rate declines significantly once the cancer has spread to other parts of the body. By detecting breast cancer before it progresses to advanced stages, many patients can avoid more aggressive forms of treatment such as chemotherapy and radiation. Treatments are often less invasive, recovery times are shorter, and overall outcomes are much better.

Importance of Self-Awareness

The first line of defense in detecting breast cancer is often self-awareness. Knowing how your breasts normally feel and look can help you notice any unusual changes. While hormonal changes during menstruation can sometimes cause temporary lumps or tenderness, persistent lumps or changes should be evaluated by a healthcare provider. Regular self-examinations are a simple yet effective way to stay vigilant. During these exams, you can feel for lumps, thickening, or changes in the breast tissue. It’s important to recognize that not all lumps are cancerous—some may be benign conditions like cysts. However, it’s crucial not to ignore any new or unusual findings. If you’re unsure how to perform a breast self-exam or what feels “normal,” consulting with a healthcare professional is a great place to start. While self-exams are helpful, they should be considered a supplementary tool. Medical screening methods like mammograms are essential because they can detect cancer long before a lump can be felt.

Mammograms and Breast Cancer Screening

Medical experts recommend regular breast cancer screenings, particularly for women over the age of 40. The most common form of screening is a mammogram, an X-ray of the breast that can detect abnormalities too small to be felt during a self-exam or clinical breast exam. Previously, mammogram screenings were recommended starting at age 50, but newer guidelines suggest beginning as early as age 40, especially for those with risk factors like a family history of breast cancer or the presence of the BRCA gene mutation. For women between the ages of 20 and 40, while routine mammograms are not usually recommended, it’s still a good idea to be familiar with your breasts and report any changes to a healthcare provider. Women are often encouraged to begin breast self-examinations in their 20s and discuss their family history of cancer with a doctor who can recommend a screening schedule tailored to their risk level.

Understanding Breast Cancer in Men

Though breast cancer is more common in women, men can also develop breast cancer, though it is much rarer. Men often overlook the possibility of breast cancer due to its association with women, but any lumps or changes in the breast area of a man should be taken seriously. Because men do not experience the same hormonal fluctuations as women, any lump in the breast area is considered abnormal. Male breast cancer is usually detected at a more advanced stage due to a lack of awareness. Just like in women, early detection significantly improves the chances of survival and makes treatment less invasive.

Risk Factors and Genetic Considerations

People with a family history of breast cancer should be particularly vigilant. If breast cancer runs in the family or if you carry the BRCA gene mutation, it’s essential to begin screenings earlier and perhaps more frequently than the general population. Genetic testing can also help in identifying risks and tailoring a screening plan suited to your situation.

Reducing Anxiety Through Screening

One often-overlooked benefit of breast cancer screening is the peace of mind it offers. Waiting and worrying about whether a lump or abnormality is cancerous can be incredibly stressful. Screening helps to either rule out cancer or diagnose it in its early stages, allowing for timely intervention. If the results of a mammogram or ultrasound come back normal, it can provide relief and reduce anxiety about breast health. On the other hand, if breast cancer is detected, the screening allows for early intervention, which leads to better outcomes and more treatment options. Breast cancer screening is a critical tool in the fight against breast cancer. Early detection saves lives, reduces the need for aggressive treatments, and improves overall outcomes. Self-awareness and routine self-examinations, along with medical screenings like mammograms, form a comprehensive approach to monitoring breast health.

Whether you’re at low risk or have a family history of breast cancer, it’s important to stay proactive about breast cancer screening. Early detection is key, and regular screenings can make all the difference in the prognosis and treatment of breast cancer.

What is a Calcium Score Test?

A Calcium Score Test is a CT (computed tomography) scan that assesses the amount of calcium in your coronary arteries. Calcium deposits can indicate plaque buildup, which may lead to heart disease.

Who Should Consider This Test?

This test is useful for individuals between 40 and 70 who are at increased risk for heart disease but do not have clear symptoms. It is particularly recommended if you:

• Have a family history of heart disease
• Use tobacco
• Have high cholesterol, diabetes, or high blood pressure
• Are overweight or obese
• Lead a sedentary lifestyle

Individuals under the age of 40 with a family history of high cholesterol may also consider undergoing this test.

Test Details

How It Works:

A Calcium Score Test involves a quick, non-invasive CT scan of the heart. You will lie on a table that moves into a scanner, while electrodes monitor your heart’s electrical activity.

What to Expect:

The scan takes a few minutes, and you may need to hold your breath briefly. The CT scanner captures images of your heart, which are analyzed for calcium deposits.

Results and Follow-Up

Understanding Your Score:

• 0: No calcium detected – very low risk of heart attack in the next 2-5 years.
• 1-10: Small amount of plaque – low risk, consider preventive measures.
• 11-100: Moderate amount of plaque – higher risk; may need additional treatments.
• 101-400: High amount of plaque – significant risk; lifestyle changes and medication may be necessary.
• Above 400: Extensive plaque – high risk; aggressive treatment and lifestyle modifications are required.

Timing for Results:

Results may be available on the same day or within a few days. Follow up with your provider if you do not receive your results within a week or if you have additional questions.

Does the Test Show Blocked Arteries?

The test measures calcium deposits indicative of plaque but does not directly show blocked arteries.

Test Limitations:

It does not detect all forms of coronary disease, such as “soft plaque.” It is a tool to assess risk rather than a definitive measure of heart health.

Key Takeaway:

The Calcium Score Test provides important insights into your heart health by measuring calcium buildup in your arteries, helping to evaluate your risk of heart disease and guide preventive measures. Feel free to discuss with your healthcare provider to determine if this test is right for you.

Heart disease remains one of the leading causes of death globally, but the good news is that many heart conditions can be prevented with the right lifestyle choices. Adopting healthy habits not only reduces the risk of heart disease but also enhances overall quality of life. In this comprehensive guide, I’ll share the top 10 lifestyle changes that can make a significant difference in your cardiovascular health.

1 Embrace a Heart-Healthy Diet

A nutritious diet is foundational for heart health. Focus on:

• Eating More Fruits and Vegetables: Aim for a variety of colorful produce to ensure a range of nutrients and antioxidants. These foods help reduce inflammation and support heart health.
• Choosing Whole Grains: Foods like quinoa, barley, and brown rice are rich in fiber, which helps lower cholesterol levels and regulate blood sugar.
• Incorporating Healthy Fats: Replace saturated fats with unsaturated fats found in avocados, nuts, and olive oil. Omega-3 fatty acids from fatty fish like salmon and sardine also support heart function and reduce inflammation.

2 Commit to Regular Physical Activity

Exercise is crucial for maintaining cardiovascular health. Aim for:

• 150 Minutes of Moderate-Intensity Exercise per Week: Activities such as brisk walking, cycling, or swimming strengthen the heart muscle and improve circulation.
• Strength Training Exercises: Incorporate strength training twice a week to enhance overall fitness and support cardiovascular health.

3 Achieve and Maintain a Healthy Weight

Excess weight increases the risk of high blood pressure and heart disease. To manage your weight:

• Combine a Balanced Diet with Regular Exercise: This approach helps in achieving and sustaining a healthy weight.
• Monitor Portion Sizes: Be mindful of portion sizes to avoid overeating, even when consuming healthy foods.

4. Quit Smoking

Smoking is a major risk factor for heart disease, as it damages blood vessels and raises blood pressure. Quitting smoking has immediate and long-term benefits:

• Improved Circulation: Your blood pressure and heart rate return to normal levels within weeks.
• Reduced Risk of Heart Disease: Former smokers have a lower risk of heart disease compared to current smokers.

5. Avoid Alcohol for a Healthier Heart

Alcohol can significantly impact your cardiovascular health, leading to elevated blood pressure and irregular heartbeats. For optimal heart health, it’s best to avoid alcohol entirely. By making this change, you not only lower your risk of heart disease but also enhance your overall well-being, increase your energy levels, and improve mental clarity.

6. Manage Stress Effectively

Chronic stress can have adverse effects on heart health. To manage stress:

• Practice Relaxation Techniques: Techniques such as meditation, deep breathing exercises, and yoga can help reduce stress levels.
• Engage in Hobbies and Leisure Activities: Make time for activities that you enjoy to alleviate stress.

7. Get Regular Health Screenings

Routine check-ups can help catch early signs of heart disease. Regular screenings include:

• Blood Pressure Monitoring: Keep track of your blood pressure to identify any issues early.
• Cholesterol and Blood Sugar Tests: Regular tests help manage risk factors associated with heart disease.

8. Stay Hydrated

Proper hydration supports overall health, including cardiovascular function. Aim to:

• Drink Plenty of Water: Aim for at least 8 glasses of water per day to keep your body hydrated and support healthy circulation.

9. Prioritize Quality Sleep

Adequate sleep is essential for heart health. To improve sleep quality:

• Maintain a Consistent Sleep Schedule: Go to bed and wake up at the same time each day to regulate your sleep cycle.
• Create a Relaxing Bedtime Routine: Engage in calming activities before bed, such as reading or taking a warm bath.

10. Foster Strong Social Connections

Positive social interactions can boost mental health and reduce stress. To enhance social well-being:

• Build and Maintain Relationships: Spend quality time with family and friends.
• Participate in Community Activities: Join groups or clubs that interest you to expand your social network.

Conclusion

Implementing these lifestyle changes can greatly reduce your risk of heart disease and improve your overall health. By adopting a heart-healthy diet, staying active, and managing stress, you can make proactive choices that support your cardiovascular system. For personalized advice and support, consider consulting with a healthcare professional to tailor these recommendations to your individual needs.

Stress is a common experience, but when chronic, it can have serious implications for heart health. Understanding how stress affects your cardiovascular system and learning effective management strategies are crucial for maintaining a healthy heart. As a consultant cardiologist, I’ll guide you through the relationship between stress and heart health, and provide actionable tips for managing stress.

How Stress Affects the Heart

Chronic stress triggers the release of stress hormones like cortisol and adrenaline, which can lead to:

• Increased Heart Rate: Persistent stress can keep the heart working harder.
• Elevated Blood Pressure: Long-term stress can contribute to hypertension.
• Increased levels of inflammation: Stress is linked to higher levels of inflammation and plaque buildup in the arteries.
• Increased blood clotting: Stress increases the chances of blood clotting
• Increased chance of plaque rupture: Sudden surges in blood pressure can lead to rupture of atherosclerotic plaque in the arteries and trigger a heart attack.

Indirect effects of stress on the heart: Chronic or repetitive stress lead to behavioral changes that can adversely affect the heart

• Smoking and alcohol intake
• Over eating, Eating unhealthy diet and weight gain.
• Lack of sleep and exercise: 

Effective Stress Management Techniques

Managing stress is important for keeping your heart healthy. Here are some simple ways to help you handle stress better:

1. Practice Mindfulness and Meditation

Engaging in mindfulness practices can help reduce stress levels by:

• Promoting Relaxation
• Enhancing Emotional Regulation
• Improving Overall Well-Being

2. Exercise Regularly

Physical activity is a powerful stress reliever. It helps by:

• Releasing Endorphins: Natural mood lifters.
• Improving Sleep Quality: Better sleep can reduce stress.
• Enhancing Cardiovascular Health: Regular exercise strengthens the heart.

3. Maintain a Healthy Diet

Eating a balanced diet can influence how your body handles stress. Focus on:

• Whole Foods: Fruits, vegetables, and lean meat.
• Reducing Caffeine and Sugar: .

4. Establish Healthy Sleep Habits

Adequate sleep is essential for managing stress. Aim for:

• 7-9 Hours of Sleep Per Night
• Consistent Sleep Schedule
• A Relaxing Bedtime Routine

5. Build Strong Social Support

Connecting with friends and family can help alleviate stress. Try to:

• Engage in Social Activities
• Seek Support When Needed
• Share Your Feelings and Concerns

6. Practice Deep Breathing Exercises

Deep breathing can help activate the body’s relaxation response. Techniques include:

• Diaphragmatic Breathing
• Progressive Muscle Relaxation

Conclusion

Understanding and managing stress is essential for maintaining heart health. By incorporating stress reduction techniques into your daily routine, you can improve your cardiovascular well-being and overall quality of life. If you need personalized guidance and support to effectively manage stress and protect your heart, Medeor Hospital in Abu Dhabi is here to help. Our experienced healthcare professionals are ready to provide tailored advice and treatment options. 

Call us today at 80055 to schedule your consultation and take the first step toward a healthier, stress-free life.

Introduction:

A 15-year-old female presented to the Ophthalmology clinic approximately 3 months ago with a history of outward deviation of the left eye along with double vision.

History of Presenting Illness:

Initially, the outward deviation of the left eye was intermittent, noticed only when she was tired, inattentive, sick, or exposed to bright sunlight. Over time, the left eye deviation progressed to being present for more than 50 percent of the waking hours, accompanied by worsening double vision or diplopia. This indicated that the Exotropia was becoming decompensated.

Initial Assessment and Differential Diagnosis:

A complete ocular examination was performed, including anterior and posterior segment examinations, as well as motor and sensory evaluations for Exotropia. The best-corrected visual acuity for both eyes was 6/6 and N6. The corneal reflex showed 45-degree Exotropia in the left eye. The cover test demonstrated that the Exotropia was alternating with right eye dominance and that control of the Exotropia was fair. Ocular movements were full in all cardinal gazes. The prism cover test revealed approximately 85 prism diopters of left eye Exotropia with tenacious proximal fusion. The sensory examination using Worth four-dot testing indicated diplopia, as the patient saw 5 circles. Both anterior and posterior segments of the eyes were normal. Systemic and neurological examinations were normal, ruling out any neurological causes for the left eye Exotropia.

Investigations and Final Diagnosis:

After thorough evaluation, the decision was made to surgically correct the squint. Major concerns included the active tenacious proximal fusion, decompensation of the deviation, and the development of diplopia. Considering these factors and the parents’ concerns, the surgery was planned for the affected eye only, allowing room for a possible secondary procedure on the better eye in the future if needed. The child underwent a left eye lateral rectus recession (9.5 mm) and medial rectus resection (6.5 mm) under general anesthesia. The surgery was uneventful, and the patient tolerated the procedure well.

Post-Operative Examination:

Post-operatively, the patient was examined the next day. The corneal reflex showed approximately 5-degree Exotropia in the left eye, the sutures appeared intact, and the patient no longer complained of double vision. The patient was discharged with instructions for post-operative care.

On the 10th post-operative day, the patient was examined in the OPD. The corneal reflex was now central, and the patient had achieved optimal single binocular vision. Both the patient and her parents were extremely happy and satisfied with the surgical outcome. She has been advised to continue her post-operative care and attend regular follow-ups.

Conclusion:

This case highlights the importance of regular eye check-ups. Not all squints require surgical correction; such decisions should be made after thorough examination. For those requiring surgical intervention, time and expertise are crucial, as they impact both the surgical motor outcome in terms of optimal ocular alignment and the sensory outcome in terms of achieving single binocular vision.

As summer winds down and the new school year looms, parents have a lot on their plates. But amid the rush for new backpacks and school supplies, there’s something even more crucial to consider: your child’s health. Let’s chat about why those back-to-school check-ups are so important.

Catching Problems Early

You know how it goes—ignore a small issue, and before you know it, it becomes a big headache. The same applies to your child’s health. These check-ups act as a safety net, catching potential problems before they become major obstacles. Maybe your little one needs glasses or perhaps they’re having trouble hearing the teacher. Spotting these issues early can make a world of difference in the classroom.

Shots, Shots, Shots!

No, not the fun kind. We’re talking about vaccines. I know, nobody likes getting jabbed, but trust me, these immunizations are crucial. They not only protect your child but also safeguard the entire school community. Plus, many schools require them, so you’re killing two birds with one stone.

Mental Health Matters

Let’s face it—going back to school can be stressful. New teachers, new classmates, maybe even a new school. It’s a lot to handle. That’s why these check-ups often include a mental health screening. If your child is feeling anxious or down, it’s better to know now and get them the support they need. Happy kids learn better, after all.

Fitness Check

Is your kid the next sports superstar? Or maybe they just enjoy a good game of tag at recess. Either way, these check-ups assess their physical fitness. It’s about making sure they’re growing well and identifying any issues that might lead to injuries down the line.

Healthy Habits 101

Your pediatrician isn’t just there to poke and prod. They’re a fountain of knowledge when it comes to keeping your kid healthy. From tips on packing nutritious lunches to advice on getting enough sleep, these check-ups are a goldmine of information.

Building a Health History

Think of these check-ups as creating a health timeline for your child. By tracking their growth and development year after year, doctors can spot any unusual changes more easily. It’s like having a health roadmap for your kid.

Squeaky Clean

And let’s not forget about hygiene. These visits are a great chance to reinforce the importance of washing hands and brushing teeth. Trust me, teachers everywhere will thank you for this!

Summer Health Tips

While we’re on the subject of health, let’s not forget about keeping our kiddos healthy during the summer months. Here are some quick tips:

• Water, water, everywhere: Keep those water bottles filled!
• Sunscreen is your friend: Slather it on, and don’t forget to reapply.
• Eat the rainbow: Summer’s the perfect time for fresh fruits and veggies.
• Get moving: Encourage outdoor play and activities.
• Unplug: Set some limits on screen time.
• Stick to a sleep schedule: Yes, even during summer.
• Safety first: Whether it’s bikes or pools, teach your kids about staying safe.

Remember, a healthy summer leads to a great start to the school year. So, book that check-up, stock up on sunscreen, and get ready for a fantastic year ahead. Your child’s health is the best school supply you can provide!

Introduction:

An inborn term neonate weighing 2600 g developed meconium aspiration syndrome (MAS) at birth. The baby experienced respiratory failure requiring high-frequency oscillatory ventilation support. Pulmonary hypertension, along with hypotension and left ventricular dysfunction noted on point-of-care echocardiography (POCE), necessitated a trial of epinephrine and inhaled nitric oxide (iNO). The case was further complicated by bilateral pneumothorax. Despite an extremely complex presentation with severe hypoxemic failure refractory to iNO, a novel treatment plan led to intact survival.

Case Presentation:

A 37-week, 2600-gram male neonate was delivered by emergency lower segment cesarean section for fetal distress and meconium-stained liquor. The antenatal period was uneventful. The baby developed worsening respiratory distress at 15 hours of life, requiring high-frequency oscillatory (HFO) ventilation with a mean airway pressure as high as 20 cm and an oxygenation index (OI) of 22. Point-of-care functional echocardiography revealed severe PPHN (pulmonary artery pressure 70 mmHg) with left ventricular (LV) dysfunction (LV fractional shortening 18%). Epinephrine was initiated to augment LV contractility, followed by iNO therapy for hypoxemic respiratory failure (HRF) secondary to severe PPHN. However, the baby turned out to be an iNO non-responder.

The Crucial Salvage:

This complex scenario of HRF with hypotension and iNO-refractory PPHN was managed by adding vasopressin infusion, which has a unique combination of vasopressor activity on systemic circulation and vasodilatory action on pulmonary circulation. The addition of vasopressin to iNO therapy helped improve hypotension and reduce pulmonary pressures. The baby also developed bilateral pneumothorax, which was managed with bilateral intercostal drainage. As blood pressure improved with epinephrine, milrinone was added to further improve PPHN due to its ino-dilatory properties.

Outcome:

Following an intricate protocol of epinephrine, iNO, vasopressin, and milrinone in a novel and crucial sequence, along with continuous bedside point-of-care functional echocardiography for monitoring LV function and PPHN, the baby was successfully salvaged and discharged on day 30 of life.

Follow-up:

At 3 months of age, the baby had appropriate weight gain and a completely normal neurological examination without any respiratory issues.

Severe PPHN: Management Strategies in iNO Non-Responders

Inhaled NO is the treatment of choice for pulmonary artery hypertension (PAH) in neonates. However, poor lung development secondary to extraneous contents in the thorax or prolonged suppression of endogenous NO synthase have been postulated as reasons for poor response to iNO. Sildenafil (a phosphodiesterase V inhibitor) and milrinone (a phosphodiesterase III inhibitor) have been used to treat PPHN non-responsive to iNO with variable success rates.

Vasopressin acts on systemic arterial V1 receptors and causes vasoconstriction. By activating pulmonary vascular endothelial nitric oxide synthase through the oxytocin endothelial receptor, it has also been reported to have pulmonary vasodilatory effects. This action helps create a high systemic and low pulmonary vascular resistance (PVR) state, thereby tipping the balance towards a higher systemic vascular resistance (SVR)ratio.

Conclusion:

This case highlights the importance of combining clinical and physiological principles of drug actions and synergisms to treat complicated cases of refractory PPHN with systemic hypotension and hypoxemic respiratory failure. Point-of-care neonatologist-performed echocardiography-based management is crucial for monitoring dynamic changes in neonatal pulmonary and cardiac functions, facilitating physiology-based, timely treatment in critically ill neonates.

Learning Points:

• This case demonstrates the potential of vasopressin in the treatment of severe pulmonary artery hypertension (PAH) that is refractory to inhaled nitric oxide.
• Vasopressin has a favorable effect on both systemic and pulmonary vasculature, unlike other non-selective pulmonary vasodilators (e.g., sildenafil) currently in use.
• Point-of-care neonatologist-performed echocardiography-based management aids in timely and physiology-based management of fragile, sick newborns.