Introduction: Exclusive breastfeeding (EBF) is currently recommended until six months of age. The Baby-friendly Hospital (BFH) initiative an international program to promote breastfeeding, was launched in Portugal in 1994. The aim of this study was to identify the prevalence and factors influencing breastfeeding in the first six months of life and to compare the results with a study carried out in 1999 including population from the same geographic area.Material and Methods: A prospective, longitudinal and observational study was carried out in two hospitals in the Lisbon metropolitan area, one BFH and another non-BFH. It consisted of different questionnaires answered by mothers at three distinct moments (zero, three and six months). The first questionnaire was applied between February and June 2019.Results: A total of 423 infants were included, 324 from the BFH and 99 from the non-BFH. The breastfeeding rate was 94.3% at discharge, 78.2% at three months and 64.4% at six months, whereas EBF rate was 74.2%, 51.8% and 25.6% respectively. All women on EBF at six months, except one, were breastfeeding on demand. The discontinuation of EBF was associated with delayed skin-to-skin contact, Neonatal Intensive Care Unit admission, pacifier and artificial teats use, mother’s return to work earlier and lower education levels. Conversely, factors that promote EBF were older gestational age, adequate birthweight, breastfeeding initiation in the first hour of life, rooming-in practice, shorter hospital stay and absence of infant’s illnesses. Compared with 1999, although there was a significant improvement of breastfeeding rates at three and six months, the EBF rate was similar at six months (23%). Both studies identified the mother’s lower education level and mother’s return to work as contributing factors to breastfeeding discontinuation.Conclusion: Our results are in agreement with previously reported causes of breastfeeding discontinuation and emphasize the importance of sociocultural factors. Compared with 1999, the breastfeeding rates in this Portuguese population increased significantly at three and six months. However, it is still necessary to improve in order to achieve the World Health Organization global target.

We present a case of a premature very low birth weight neonate who developed abdominal distension and acute anemia on his 2nd day of life, in which a liver laceration was diagnosed. Neonatal hepatic injury is rare but frequently fatal. It usually happens due to perinatal trauma in complicated labor or delivery or when resuscitation maneuvers take place. It can result in a subcapsular hematoma of the liver but can also translate as a simple laceration. When the hepatic capsule ruptures, a hemoperitoneum usually develops. Umbilical vein catheterization, hepatic congestion and an increased bleeding tendency have also been associated with liver injury and hemorrhaging in the neonate. Clinical presentation can vary from abdominal distension to acute anemia or even hemorrhagic shock. Unspecific signs such as lethargy, tachypnea, feeding intolerance, jaundice and laboratory findings of thrombocytopenia, coagulation disturbances and hyperbilirubinemia can occur. Diagnosis may be difficult, and imaging methods are essential. A conservative approach to treatment is usually preferred, even in the case of a hemoperitoneum. In the case described, there was a history of a difficult extraction and need for resuscitation maneuvers at birth. The abdominal radiograph showed a large liver, and ultrasound revealed a hepatic laceration and a hemoperitoneum. Treatment was supportive, consisting of blood components, expectant observation and strict avoidance of abdominal manipulation. Follow-up of the lesion through serial ultrasounds was performed, and the infant survived, recovering well. This case is one of the few in recent literature describing a good outcome in neonatal liver injury. Awareness of the possibility of its occurrence is important, especially in premature neonates, who are at particular risk.

Quantitative morphologic parameters assessed in cytologic samples of canine cutaneous mast cell tumors (ccMCTs) may assist with surgical planning and prognostication. Robust cutoffs can be defined, with high reproducibility, for parameters such as the nuclear area (NA). The NA may be determined by morphometry (image analysis, NAI) or by stereology, such as the 2D-nucleator method (NAN); stereologic techniques have not been applied to cytologic specimens of ccMCT, to our knowledge. We retrospectively selected routine cytology smears from 51 ccMCT cases and screened them to determine the percentage of neoplastic mast cells with indistinct nuclear borders; this was repeated after the slides were restained with H&E. The NAI and the NAN were estimated in 100 mast cells per animal in H&E-stained slides. All nuclei were visible in H&E smears, and unbiased quantification was feasible. The NAN was similar to NAI, but less time-consuming. Both the NAN and NAI determined by cytology differed in histologic low- and high-grade ccMCTs, and in histologic grade I plus II versus grade III ccMCTs. Stereologic parameters such as the NAN could be considered as complementary techniques for the cytologic evaluation of ccMCTs.

Journal of Paediatrics and Child HealthVolume 57, Issue 7 p. 1142-1142 Image of the Month Cauliflower scare Dr Joana Marques, joana.immarques@gmail.com orcid.org/0000-0002-9974-8910 Neonatal Intensive and Special Care Unit, Pediatrics Department, Hospital Prof. Doutor Fernando Fonseca, EPE, PortugalVerbal consent was given by the child's mother to photograph the lesion. The mother was informed that the photograph could be used in scientific publications.Search for more papers by this authorDr Rosalina Barroso, Neonatal Intensive and Special Care Unit, Pediatrics Department, Hospital Prof. Doutor Fernando Fonseca, EPE, PortugalSearch for more papers by this author Dr Joana Marques, joana.immarques@gmail.com orcid.org/0000-0002-9974-8910 Neonatal Intensive and Special Care Unit, Pediatrics Department, Hospital Prof. Doutor Fernando Fonseca, EPE, PortugalVerbal consent was given by the child's mother to photograph the lesion. The mother was informed that the photograph could be used in scientific publications.Search for more papers by this authorDr Rosalina Barroso, Neonatal Intensive and Special Care Unit, Pediatrics Department, Hospital Prof. Doutor Fernando Fonseca, EPE, PortugalSearch for more papers by this author First published: 03 July 2021 https://doi.org/10.1111/jpc.1_15318 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume57, Issue7July 2021Pages 1142-1142 RelatedInformation

Introduction: Inverted papillomas represent one of the most common benign neoplasic lesions located in the sinonasal tract. Owing to the local erosive behavior, tendency to recur and the potential for malignant transformation, surgical management of inverted papillomas is often challenging. Objective: This study aimed to analyze the surgical outcomes of patients with inverted papillomas, according to the Krouse staging and the different surgical approaches. Methods: Retrospective study of patients diagnosed with sinonasal inverted papillomas who underwent surgical treatment between 2000 and 2016 at a tertiary referral hospital. Cases with follow-up less than 12 months were excluded. The rate and the time of recurrence were the main outcomes. Values of p < 0.05 were considered statistically significant. Results: Thirty-six cases with mean age of 60 years, predominantly male (72%), were included. The follow-up period ranged from 1 to 16 years, with an average of 4.5 years. Krouse T1 Stage corresponded to 11.1%; T2 occurred in 50% of cases; while T3 and T4 Stages accounted for 30.6% and 8.3% of patients, respectively. Most cases were approached by an endoscopic technique alone (83.3%), with a recurrence rate of 13.3%. Patients treated via a combined or open approach revealed a recurrence of 16.7%. No differences in the recurrence rate were reported when comparing endoscopic surgery with the open or combined techniques. Krouse Stage T3 had a significant association with inverted papillomas recurrence (p = 0.023). All inverted papilloma relapses occurred up to 2 years post-operatively. One case of malignant transformation was recorded (2.7%). Conclusion: Endoscopic surgery did not increase the recurrence rates and can be a safe and efficient alternative to open or combined techniques. The recurrence of inverted papillomas seem to be related to the persistence of the disease and tend to occur early after primary surgery. Krouse T3 Stages may be associated with a higher recurrence of inverted papillomas.

Introduction:Adolescence is characterized by impetuosity, which can lead to fatalities-suicide, assault, and transport deaths, the key being access to lethal means.This population-based study examines violent deaths in the 21st Century by comparing America with nineteen Other Western Countries' (OWC).Method: All mortality data is drawn from WHO latest report, comparing bases-line years 2000-02 to index years 2013-15 for Youth (15-24years) of both sexes.Changes in Youth rates per million (pm) of these three types of violent deaths are calculated and for Total mortality the Age-Standardized-Deaths-Rates (ASDR).Chi square test are used to compare each OWC with the USA outcomes.Based upon the world-small-arms survey national gun ownership per thousand persons (ptp) are examined and rank order correlations used to determine any possible association.Results: Over the period USA Suicide rates increased for Youth by 16%, the average in OWC was a 22% fall.American Youth Assault rate was almost double the Total ASDR (99pm to 55pm respectively) and Youth and ASDR rates were more than fight times the OWC average.USA Youth Transport deaths at 158pm were double the average of other countries.USA gun ownership far exceeded OWC, correlating with Youth suicide.Conclusions: USA Youth Violent death rates are worse compared with most OWCs, especially increased suicide, which correlated with gun ownership.Youth Assaults and Suicide this century numbered 142,784 or 8,924pa.There is a specific need for specific public health focus on American Youth violent deaths which are even higher than recent US military losses.