bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Different Nutrient Management Systems on Yield and Yield Components of Rice Crop (Oryza sativa L.) in the Dry Zone of Sri Lanka
Authors: Wickramasinghe W. M. D. M. , Egodawatta W. C. P. , Devasinghe D. A. U. D. , Beneragama D. I. D. S. , Suriyagoda L. D. B.
Published: September 2023

Purpose: Integrated and organic nutrient management has recently become the focus in Sri Lanka for seeking better perspectives on food quality and environmentally friendly production. This study was conducted to understand the magnitude of yield and yield components under selective nutrient management systems in major cropping seasons within the transitional period of a conventional rice-based cropping system. Research Method: Rice yield components and yield were measured with different nutrient management systems; conventional, integrated, and organic from Yala 2019 to Maha 2020/21. An ANOVA was carried out using the Repeated Measures MIXED model to determine the effect of nutrient management systems on yield and yield components for four continuous cropping seasons. Findings: Total tillers per hill and productive tillers per hill significantly varied with conventional, integrated, and organic systems in descending order. The number of filled spikelets per panicle (43) was significantly increased, and the number of hollow spikelets per panicle (8) and thousand-grain weight (21.5g) were significantly decreased with an organic system in the Yala 2019 season only. Although the biological and expected grain yields of the Yala 2019 season were significantly higher with the conventional and integrated systems, these did not change significantly with the organic system in the last two seasons. Research Limitations: Yield parameters fluctuated due to weather changes in different seasons; thus specific impacts of different nutrient managements have been masked to a certain degree. Originality/ Value: The attempt to convert conventional crop production systems in Sri Lanka to organic can be effectively achieved using the integrated use of nutrients and crop rotations.
Present status of micro-livestock production in the Anuradhapura district, Sri Lanka
Authors: Jayasooriya P. R. D. M. , Dissanayake S. P. , Kopiyawattage K. P. P. , Somasiri S. C.
Published: September 2023

Purpose: Indigenous species and non-popular species are referred to as micro-livestock (ML). Micro-livestock farming provides numerous socio-economic benefits. However, attention for ML rearing is low. Hence the purpose of this study is to find the present status of ML farming in Anuradhapura district in order to provide suggestions to popularize ML as a livelihood and income-generation option among rural communities.Research Method: A survey was conducted with 72 ML farmers selected from multi-stage random sampling in the Anuradhapura district.  Descriptive statistics were used to analyze the socio-economic status of farmers and production details of ML farming.  Logistic regression model was used to analyze the drives of ML farmers’ decisions on market participation.Findings: Village chicken was the most popular due to high demand for eggs. Feeding was the least cost component in ML farming. Potentials to expand ML rearing were low labour cost and cost of production and availability of market and infrastructure. Majority of the farmers sell their products to retailer shops. Marketing of ML products is influenced by gender, age, training and distance to market. Lack of technical support and markets, poor extension, diseases, predators and climatic change were identified as constraints for ML rearing.Research Limitations: Micro-livestock farming is the least considered farming practice in the area. The farmers were scattered and they kept ML as a secondary activity. Originality/value: There is a potential to expand ML farming in the area as a remedy for malnutrition and poor income in rural households especially the females.
Proper hydration is central to the health and well-being of children 
Authors: Bandara Thushari , Fernando G. H. S.
Published: September 2023

No abstract available
Sharenting: How much is too much?
Authors: Rohanachandra Yasodha Maheshi
Published: September 2023

No abstract available
Clinical and demographic characteristics of organic acidaemias in children in a tertiary care hospital in Sri Lanka: A 4-year experience in a single centre
Authors: Vidanapathirana D. M. , Fernando P. M. S. , Jayasena K. L. S. P. K. M. , Chandrasiri N. D. P. D. , Gunaratne A. V. , Samaranayake D. , Jones P. M. , Jasinge E.  A.
Published: September 2023

Background: Organic acidaemias (OAs) are a biochemically heterogeneous group of inborn errors of metabolism. They are rare and infrequently reported worldwide. Most OAs are clinically apparent in the neonatal period or early infancy while some can present as a chronic progressive form or even an asymptomatic form. Objectives: To describe the clinical presentation, demographic characteristics and the incidence of OAs in Sri Lankan children. Method: A retrospective descriptive cross-sectional study was conducted over a 4-year period by reviewing records of children suspected of having OAs referred to the Department of Chemical Pathology, Lady Ridgeway Hospital. Demographic information, clinical manifestations, biochemical investigations and mutational results were recorded and analysed using descriptive statistics. Definitive diagnosis was established by gas chromatography and mass spectroscopy (GC-MS) of urine for organic acids.  Results: Among the 458 patients suspected, 20 (4.3%) were confirmed to have an OA resulting in an incidence of 13/319,000 live births per year. The mean ages at onset of symptoms and diagnosis were 11.8 months (range; day 1 to 5 years) and 27.1 months (range; day 10 to 12 years) respectively. Among the 20 patients were 5 (25%) with propionic acidaemia and 4 (20%) with beta-ketothiolase deficiency. Nineteen (95%) presented acutely. Common manifestations were respiratory distress in 12 (60%) and persistent or recurrent vomiting in 10 (50%). Learning difficulty, dyskinesia and macrocephaly were some chronic manifestations. Biochemically, 15 (75%) had acidosis and 9 (45%) had ketosis. There were 13 (65%) deaths of which 6 were neonates with acute presentation. Conclusions: Propionic acidaemia and beta-ketothiolase deficiency were the common OAs identified. Common clinical presentations were respiratory distress and persistent or recurrent vomiting. Acidosis was a common biochemical finding.
Wound healing and analgesic effects of Brocchia cinerea essential oil in experimental animals
Authors: Lakache Zineb , Aliboudhar Hamza , Sadallah Mohcene , Hacib Hinda , Fekiri Meryem , Zergat Amina Ihssane , Tounsi Hassina , Kameli Abdelkrim
Published: September 2023

This study aimed to identify the main components of the essential oil extracted from Brocchia cinerea (Delile) Vis. via hydrodistillation and investigate its in vivo wound healing and analgesic properties. Thujone, santolina triene, camphor, and 1,8-cineole were among the compounds detected. Wounds were induced in mice and treated with essential oil, which resulted in accelerated wound healing and repair through topical application (88.1±1.1%). The study also evaluated the analgesic activity of the essential oil by administering intraperitoneal injections of acetic acid to mice. The results showed that B. cinerea essential oil at a dose of 400 mg/kg strongly inhibited pain, with a pain inhibition percentage of 95.5%. These findings indicate that the essential oil of B. cinerea has potential as a source of bioactive compounds that may have synergistic effects. Based on these results, the use of B. cinerea for therapeutic purposes in preventing pain and promoting wound healing is supported. These findings highlight the potential of B. cinerea in paving the way for future research aimed at the development of clinically valuable products.
Abortifacient activity of Aegle marmelos and Laurus nobilis leaf extracts
Authors: Jillelamudi Supriya , Ankem Narendra Babu , Jada Naga Lakshmi
Published: September 2023

Rapid elevation of population in India is the one of the major problems, which directly influence the economy of country and may lead to poverty. Government implemented number of family planning programs through the various surgical operations (tubectomy and laproscopy) and oral contraceptives. Usage of oral contraceptive pills may lead serious complications, and may induce congenital abnormalities. The primary goal of this research is to assess the abortifacient activity in rat models of two historically used medicinal plants, Laurus nobilis L. and Aegle marmelos (L.) Corr. Restructure the paragraph as the study included 18 female wistar rats (150-200 g) and six male wistar rats (male wistar rats were used only for copulation). Female rats in proestrous phase were isolated and allowed to mate with males of proven fertility using the mass mating technique in a 3:1 ratio for an overnight. Control animals received an equivalent volume of the dosing vehicle (1% tween 80) orally. Aqueous extract of Laurus nobilis (AQLN) leaves and Ethanolic Extract of Aegle Marmelos leaves (EEAM) at doses of 175 mg/kg and 250 mg/ kg of were orally administrated daily for 10 days from day 0 of pregnancy to day 9. On day 20th of pregnancy, all the animals were sacrificed under euthanasia and the uterine horns were isolated, later they were examined for number of abortifacient sites and deformities of fetuses. The number of live fetuses in animals treated with EEAM at two doses was substantially lower in Group-4 at 175mg/kg (2.63 + 0.36) and Group-5 at 250mg/kg (1.87 + 0.40) compared to the vehicle control group (p 0.05, p 0.01). The survival ratio decreased considerably from 52.2% to 28.8% as the dose increased. Similarly, the abortion rate was higher in group 5 compared to Group-4. AQLN demonstrated to have 100% abortifacient efficacy at 250mg/kg, while EEAM has 83.3%.
Pattern of Allergen Sensitivity among Patients with Allergic Rhinosinusitis in North-East India
Authors: Sarma Nayanjyoti , Khaund Gautam
Published: September 2023

Introduction:

The distribution of allergens varies among various geographical areas of India and the knowledge of allergen sensitivity pattern in North-East India is limited. These data can provide clinically useful information and better understanding of common allergies prevalent in this area.

Aim:

The aim of the study was to study the pattern of allergen sensitivity among patients with allergic rhinosinusitis.

Materials and Methods:

In this retrospective study, patients diagnosed with allergic rhinitis who underwent skin prick testing were included in the study. Patients who had taken drugs that could affect the test results, within 1 week before testing were excluded. Furthermore, patients on long-acting oral antihistamines within 4 weeks of testing and pregnant women were excluded. A total of 42 antigens were used which included three types of dusts, 14 types of pollens, 7 types of fungi, 2 types of animal dander, and 16 types of food items. Skin prick testing was done as per standard protocol.

Results:

Out of 100 patients, 53 (53%) were males and 47 (47%) were females. Overall, the highest percentage of skin prick test positivity was found for Dermatophagoides pteronyssinus dust mite (63%), Hen’s Egg (43%), Aspergillus fumigatus mold (32%), and Ragweed pollen (27%), in that order.

Conclusion:

Our study will be useful in providing information on the pattern of allergen sensitization in North East India.
Quantitative assessment of ultrasound-guided sciatic nerve block – A comparison of a single-point versus two-point injection technique: A randomised controlled, double-blinded trial
Authors: Nag Kusha , Ravishankar M , Parthasarathy S , Thomas Tina M.
Published: September 2023

Background and Aims:

Sciatic nerve block at the popliteal level for lower limb procedures provides unpredictable success rates even with ultrasonographic (USG) guidance. This study aimed to compare USG-guided single-point versus two-point injection techniques.

Methods:

Sixty patients posted for foot surgeries under USG-guided sciatic nerve block were randomised into Group Single Point, receiving a single injection of 20 mL of 1.5% lignocaine with adrenaline just proximal to the sciatic nerve bifurcation, and Group Double Point, receiving two injections of 10 mL of 1.5% lignocaine with adrenaline, one at the point similar to the first group and a second injection 6 cm above the first point. Sensory blockade onset, time to complete sensory blockade, time to complete motor blockade, length of the nerve exposed and analgesia duration were evaluated. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) statistics version 20 software.

Results:

Double-point injection technique showed a significantly faster time to complete motor blockade [14.46 (9.93) min], increased length of nerve exposed to local anaesthetic [23.23 (7.209) cm] and extended duration of analgesia [420.40 (99.34) min] compared to the single-point injection technique [20.89 (12.62) min, 18.78 (5.95) cm and 344.28 (125.97) min, respectively]. The onset of sensory blockade and the time to complete sensory blockade were comparable between the two groups.

Conclusion:

USG-guided popliteal sciatic nerve block with a double-point injection technique does not significantly shorten the time to complete the sensory block. However, the time to complete motor nerve block and duration of analgesia are prolonged significantly, which may be clinically beneficial for postoperative analgesia.
Analgesic efficacy and safety of duloxetine premedication in patients undergoing hysterectomy – A systematic review
Authors: Nair Abhijit , Thakre Manish , Rangaiah Manamohan , Dudhedia Ujjwalraj , Borkar Nitinkumar
Published: September 2023

Background and Aims:

Patients undergoing hysterectomy by open or laparoscopic approach experience moderate to severe postoperative pain. A multimodal analgesic approach is recommended for these patients. This study reviews the analgesic efficacy of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor used as an adjuvant for opioid-sparing postoperative analgesia.

Methods:

After registering the protocol in the international prospective register of systematic reviews (PROSPERO), databases like PubMed, Ovid, Scopus, Cochrane Library and clinicaltrials.gov were searched for randomised controlled trials using relevant keywords to find studies in which duloxetine premedication was compared to a placebo in patients undergoing hysterectomy. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of evidence.

Results:

The qualitative systematic review included five of the 88 studies identified. The overall risk of bias in the included studies was very high. In all the studies, 60 mg oral duloxetine was used, and the control group was placebo. In two studies, duloxetine premedication was administered 2 h before and 24 h after surgery. In the other three studies, a single dose of 60 mg duloxetine was only administered 2 h before surgery. A pooled meta-analysis was not performed due to fewer studies that fulfilled the inclusion criteria and even fewer studies with consistent reporting of various outcomes.

Conclusion:

The evidence is insufficient to advocate routine duloxetine premedication in patients undergoing hysterectomy.
Comparative assessment of dexmedetomidine and butorphanol for attenuation of etomidate-induced myoclonus: A double-blind, randomised controlled study
Authors: Rautela Rajesh S. , Gulabani Michell , Kumar Pramod , Salhotra Rashmi , Mohta Medha , Verma Kshitiz
Published: September 2023

Background and Aims:

Etomidate is a popular induction agent, but its use is associated with myoclonus in 50%–80% of non-premedicated patients. This study aims to compare dexmedetomidine and butorphanol for their relative efficacy in preventing etomidate-induced myoclonus.

Methods:

This randomised study was conducted after obtaining institutional ethical committee clearance and written informed consent from sixty American Society of Anesthesiologists (ASA) I or II consenting patients between 18 and 60 years of age of either sex who had been scheduled for elective surgeries under general anaesthesia. Patients were randomly allocated to dexmedetomidine 0.5 μg/kg (Group D) or butorphanol 0.015 mg/kg (Group B). Both the drugs were given as an infusion over a period of 10 min before induction of anaesthesia. The primary outcome was the incidence of myoclonic movements after etomidate, and the secondary outcomes were the severity of myoclonus, changes in the haemodynamic parameters and incidence of airway complications. Normally distributed variables were compared using Student’s t-test, and non-normally distributed variables were compared using Mann–Whitney U test. Qualitative data were analysed using Chi-square/Fisher’s exact test. A P-value <0.05 was considered significant.

Results:

The incidence of etomidate-induced myoclonus was significantly higher in group B compared to group D (P = 0.035). The median (interquartile range [IQR]) of myoclonus grade in patients of group D was 0.00 (0.00–3.00), and group B was 2.50 (0.00–3.00) (P = 0.035). Haemodynamics and airway-related complications were comparable between the groups.

Conclusion:

Dexmedetomidine was more effective than butorphanol in preventing etomidate-induced myoclonus.
Efficacy of intertruncal and corner-pocket approaches of ultrasound-guided supraclavicular block in terms of ulnar nerve blockade: A randomised controlled study
Authors: Trivedi Saurabh , Gupta Srishti , Bhardwaj Hemendra , Sahoo Tapan Kumar , Gupta Seema , Trivedi Gaurav
Published: September 2023

Background and Aims:

The incidence of ulnar nerve sparing has declined with the corner-pocket approach of the supraclavicular block (SCB), however, it continues to persist. A recent technique of SCB, the intertruncal approach, separately blocks each trunk of the brachial plexus. Thus, we hypothesised that the intertruncal approach results in a complete ulnar nerve blockade.

Methods:

Eighty-eight patients were randomised to undergo SCB using an ultrasound (USG)-guided corner-pocket or intertruncal approach and were compared primarily regarding the complete sensory and motor blockade of the ulnar nerve and all four nerves (ulnar, radial, median and musculocutaneous nerves) at 15 min. Secondary objectives included time required for block performance, patient discomfort score, time to readiness for surgery and duration of sensory blockade of the ulnar nerve. Continous data were compared using an independent t-test, and categorical data were compared using the Chi-square test.

Results:

The proportion of participants with complete sensory (30/44 vs. 14/44, P < 0.001) and complete motor (22/44 vs. 7/44, P < 0.001) blocks in the ulnar nerve and all four nerves at 15 min was significantly higher in the intertruncal group. Block performance time and patient discomfort score were higher in the intertruncal group (P < 0.001). The total duration of sensory blockade in the ulnar nerve was more in the corner-pocket group (P < 0.001).

Conclusion:

USG-guided intertruncal approach is superior to the corner-pocket approach of SCB regarding a complete ulnar nerve blockade.
Spiritual coping strategies: Relationship with physical, anxiety, and depression symptoms of patients with cancer
Authors: Ahmadi Atefeh , Heidarzadeh Aazam , Dehghan Mahlagha , Safarizadeh Mohammah Hossein , Forouzi Mansooreh Azizzadeh
Published: September 2023

Introduction:

Spirituality is considered an important source against chronic diseases and can promote self-esteem, mental comfort, and hope in patients. Concerning its importance, the present study aims to investigate spiritual coping strategies and its relationship with physical, anxiety, and depression symptoms of patients with cancer who are referred to the oncologic ward.

Method:

This was a descriptive-correlative study that 159 patients with cancer participated in the study. Information was collected using a four-part questionnaire including sociodemographic characteristics, Spiritual Coping Strategies Scale, physical symptoms as well as anxiety and depression symptoms. Data were analyzed using the Mann–Whitney U test, Kruskal–Wallis, and Spearman correlation coefficient.

Results:

Results of the study showed that the mean (±SD) of the application of methods of spiritual coping strategies was 35.69 ± 10.92 and for its subscales the mean (±SD) of the application of religious coping and nonreligious coping strategies were 16.92 ± 5.6 and 18.77 ± 6.24, respectively. Furthermore, physical symptoms perceived by patients were tiredness, drowsiness, and lack of appetite. There was no significant correlation between physical, anxiety, and depression symptoms and spiritual coping strategies (r = -0.12, P = 0.12; r = 0.07, P = 0.41; and r = -0.05, P = 0.5 respectively).

Discussion:

Regarding no significant relationship between physical, anxiety and depression symptoms and spiritual (religious and nonreligious) coping strategies in this study, belief towards cancer and cultural aspects of patients may be more essential to their sense of wellness and help them to cope with negative aspects of illness or treatment. Therefore, more study needs to be done in this area.
Pneumothorax in lung metastasis of advanced soft tissue sarcoma patients treated with oral pazopanib
Authors: Sarkar Sayan , Mishra Pradipta Kumar , Mukhopadhyay Sumit , Sen Saugata , Biswas Bivas
Published: September 2023

Aim:

Data on occurrence of pneumothorax after the use of oral pazopanib in advanced soft tissue sarcoma (STS) with lung metastases are scarce in literature. We aimed to evaluate those in our patients.

Methods:

This was a single center retrospective study of incidence of pneumothorax in patients with lung metastases in advanced STS treated with oral pazopanib between July, 2016 and December, 2020. Patients were treated with pazopanib usually from 2nd line onwards with a dose ranging from 400 mg to 800 mg once daily.

Results:

Total of 34 patients with lung metastasis in a setting of advanced STS were treated with oral pazopanib during the study period. The setting of pazopanib use was 2nd line in four and 1st line in one of them. The starting dose was 600 mg once daily in three patients, 400 mg OD in one patient, and 800 mg OD in one patient. Five patients developed pneumothorax with duration on pazopanib of 6, 7, 24, 6, and 2.5 months, respectively. Three patients had symptoms and required chest tube drainage. None of them were smokers or had any other underlying lung disease. The disease response of those patients was stable disease in four and partial response in one during treatment with pazopanib. One patient had a rechallenge with further pazopanib course without any recurrence of pneumothorax.

Conclusions:

Pneumothorax is a rare pulmonary complication after pazopanib use in patients with lung metastasis. Clinicians should be aware of this rare complication as literature is scarce. Rechallenge with pazopanib is feasible after pneumothorax.
Comparison of psychosocial impact of strabismus on pediatric and adult patients in India
Authors: Bandhu Seema Dutt , Raje Swati S. , Kaur Barinder , Moudgil Tania , Bansal Yashi
Published: September 2023

Purpose:

The purpose of this study was to compare the psychosocial impact of squint on children with that on adult patients in India.

Materials and Methods:

In this descriptive cross-sectional study, a twenty-question quality-of-life instrument ASO-20 was administered to patients with strabismus to study the psychosocial impact of strabismus on them. The results were compiled in an Excel sheet and analyzed statistically.

Results:

Thirty-two children (5–18 years) and 24 adults (>18 years) were included in the study. It was observed that all the adults responded that they always noticed that they have strabismus as against significantly less (81.25%) number of children who did so. Similarly, 75% of adults responded that strabismus affected their relations with other people, whereas only 37.5% of children felt that strabismus affected their relations with other people. While 95.83% of adults felt that opportunities (social interaction or at work) were fewer because of strabismus, only 37.5% of the children felt so. Similarly, while all the adults responded that they frequently imagined that other people were thinking about their eyes, only half of the children (56.25%) felt so. The difference is statistically significant. Significantly more (83.3%) adults responded that they had more difficulty in making friends because of strabismus, as against this, only one-fourth (25%) of the children felt so. The difference is statistically significant. Both the groups felt that strabismus bothered them, people noticed strabismus while interacting with them and they felt different (inferior) because of strabismus. Although the percentage who felt so was more in adults as compared to children, the difference was not statistically significant. Similarly, more children (75%) said that strabismus never hindered their performance as compared to adults (66.67%), however, the difference was not statistically significant.

Conclusions:

Strabismus has negative psychosocial effects on the affected individual which intensify with age.
A comparative study to assess the accuracy of the SRK T and HOFFER Q formulas in the intraocular lens calculation of long eyes undergoing phacoemulsification with posterior chamber intraocular lens in a tertiary care center
Authors: Kumar H. Mohan , Apoorva N. , Shreya  , Rachana B. , Rasheed Sana , Soni Jyotsana
Published: September 2023

Aims and Objectives:

The aim is to compare the accuracy of the SRK T and HOFFER Q formulas in intraocular lens (IOL) power calculation in long eyes by noting the postoperative visual outcome.

Introduction:

Senile cataract is a leading cause of blindness in India. Cataracts are managed by cataract extraction with implantation IOL. Before surgery, IOL power is calculated by biometry. IOL power calculation is the main key to obtaining a good refractive outcome after cataract surgery.

Materials and Methods:

A hospital-based study was conducted prospectively to evaluate IOL power using SRK T and HOFFER Q formulae in patients undergoing phacoemulsification with posterior chamber intraocular lens in long eyes over a period of 18 months. Thirty patients were studied based on inclusion criteria. A detailed clinical examination, pre- and postoperative visual acuity, anterior chamber depth (ACD), and refraction were done on day 30 postsurgery.

Results:

The study included 30 cases with 15 patients in either group, of which 63% were male and 37% were female; 95% of the patients were aged above 50 years; the maximum number of patients in either group had an axial length in the range of 24.5–25 mm; the maximum preoperative ACD was between 3 and 4.5 mm and the maximum postoperative ACD was between 4 and 4.5 mm in both groups; 40% of the patients in either group had 6/6 vision; spherical refractive error postoperative was seen in 73% in the SRK T group and 68% in the HOFFER Q group; and cylindrical refractive error was seen in 27% in SRK T group and 32% in HOFFER Q group.

Conclusion:

Either formula can be used for IOL power calculation in eyes up to 26.5 mm, as not much difference in postoperative refractive error was observed. Both formulas had a lesser degree of spherical error and an equally good visual outcome postoperatively. Careful biometry is important to prevent postoperative surprises.
Correlation of diabetic retinopathy with thyroid status
Authors: Sachdeva Lalit , Srivastava Neha , Yadav Vishal , Srivastava Anil Kumar
Published: September 2023

Background:

Several studies have demonstrated a correlation between subclinical hypothyroidism (SCH) and diabetic retinopathy (DR) with conflicting results. The study is aimed to find out the correlation and severity of DR with thyroid status.

Materials and Methods:

A cross-sectional study was conducted taking up 59 patients of DR and categorized them according to the severity of DR as per early treatment DR study classification. Thyroid stimulating hormone (TSH), free thyroxine (FT4), and FT3 concentration were measured in all 59 patients. Patients with normal TSH and FT4 values are euthyroid patients and those with normal FT4 but TSH >4.12 mIU/L is considered having SCH and those with FT4 <0.93 ng/dL and TSH >4.12 mIU/L are considered having hypothyroidism. The severity of DR is compared between the euthyroid, subclinical hypothyroid, and hypothyroid groups.

Results:

Out of the 59 patients included in the study, 23 (38.98%) were females and 36 (61.01%) were males. Out of 59 cases of DR, 51 (86.44) cases were diagnosed with nonproliferative DR (NPDR) and 8 (13.56%) were diagnosed with PDR. Fifteen had thyroid dysfunction, SCH were seen in 13 patients, two patients had hypothyroidism, and 44 had euthyroid. Fifty-one patients of NPDR and SCH were seen in seven patients, and hypothyroid was present in two patients. In eight patients of PDR, six had SCH.

Conclusions:

In the present study, the prevalence of SCH among the patients of DR with type 2 diabetes mellitus (DM) was found to be 20.33%. The prevalence of severe NPDR and PDR was higher in patients with SCH compared to euthyroid patients. Therefore, SCH is associated with the severity of DR.
A novice technique of “Dumbbell suture” IOL flange procedure with penetrating keratoplasty
Authors: Singh Shakeen , Utaal Shubhneek Kaur Dhillon , Kaur Divnoor
Published: September 2023

The purpose of this study is to describe the scleral fixation of intraocular lens (IOL) using the IOL flange technique combined with penetrating keratoplasty. The technique is a modification over the previous Yamane’s transconjunctival double-needle flanged-haptic technique of intrascleral fixation of IOL as it involves the use of 5-0 prolene suture to create an IOL flange, and the IOL is placed in the sulcus. With this technique, there are less chances of haptic and vitreous drag as compared to the previously described techniques. This combined procedure is easy to learn, execute and economical with additional advantage of added IOL stability and can be of great benefit for patients with aphakia and no posterior capsular support.
Infected cornea graft mimicking scleral tissue transplant: A deviant case of failed graft with dystrophic calcification and secondary fungal infection
Authors: Nayana V. , Balasubramaniam Anand , Sreelakshmi R.
Published: September 2023

A 56-year-old female patient presented with vision loss in right eye (OD) for the past 6 months with whitish discoloration of the eye; the patient underwent therapeutic keratoplasty 1 year back elsewhere, and was on treatment with topical fortified antibiotics, lubricants, and antiglaucoma medications for 6 months. On examination, a chalky white opacified graft was noted, simulating scleral tissue transplant with edematous vascularized host corneal tissue. Corneal scraping was positive for fungal elements on potassium hydroxide mount, and culture on Sabouraud agar reported hyalohyphomycetes growth. Therapeutic keratoplasty was performed, and histopathological evaluation (HPE) revealed corneal tissue with areas of necrosis, karyorrhectic debris with mixed inflammatory cell infiltrate, and dystrophic calcification in the stroma.
Characteristics, Surgical Management, and Outcomes of Parotid Gland Masses in the Pediatric Age Group
Authors: Murugan Raghunath Sambandam , Maniam Raghul , Dhanasekarapandiyan Vembar , Hariharan G.
Published: September 2023

Context:

Parotid gland lesions in children requiring surgical management are not common. Neoplastic lesions of the parotid glands are also less common. Parotid tumors in children have different characteristics from those that occur in adults. When they occur in the pediatric age group, malignancy has to be ruled out.

Subjects and Methods:

This is a retrospective study of children who presented to our institute, a tertiary care referral hospital for children <12 years, with parotid swellings during the 5-year period between April 2018 and March 2023. The children who underwent surgical management for parotid lesions, in the form of parotidectomy, were included in the study. Children who were treated by nonoperative management were excluded from the study.

Results:

Twelve children were included. Of the 12 children, three (25.0%) children had malignancy, four (33.33%) children had benign tumors, three (25.0%) children had vascular malformations, and the remaining two (16.67%) children had inflammatory etiology. All children underwent superficial/total parotidectomy, depending on the involvement of superficial and/or deep lobe. Of the three malignant parotid tumors, two were of mucoepidermoid carcinoma and one was myoepithelial carcinoma. One of the children with mucoepidermoid carcinoma had recurrence.

Conclusions:

Facial nerve-sparing parotidectomy is the treatment for neoplastic and inflammatory lesions. Initially, lymphovascular tumors were treated aggressively with parotidectomy. Neck node dissection should be performed only in children with fine-needle aspiration cytology-confirmed nodal metastases during primary surgery. Adjuvant treatment may be required in selected cases.
Variation in the Expression of Interstitial Cell of Cajal-like Cell (CD117) Across Congenital Pelvic-ureteric Junction Obstruction and its Renal Sonological and Functional Correlation
Authors: Ashish Kumar , Ratan Simmi K. , Sarin Yogesh Kumar , Khurana Nita , Kumar Jyoti
Published: September 2023

Aims and Objectives:

This study aims to study the variation in the expression of CD117-positive interstitial cells of Cajal-like cells (ICC-LC) across the upper urinary tract region in children presenting with pelvic-ureteric junction obstruction (PUJO) and its association with renal functional and sonological parameters of patients.

Materials and Methods:

A prospective observational study was done on 20 children with congenital PUJO who underwent dismembered pyeloplasty. All children underwent renal sonography (anteroposterior pelvic diameter [APPD], pelvicalyceal ratio [P/C ratio], Mid polar renal parenchymal diameter [MPPD]) and functional imaging scan (LLEC scan or DTPA scan). Three specimens were taken intraoperatively from above PUJ, at the level of PUJ, and below PUJ. Those were examined immunohistochemically using CD117 to count ICC-LC using standard criteria. Variation in the expression of CD117-positive ICC-LC was correlated with the abovestated parameters.

Results:

The number of CD117-positive ICC-LC showed a continuous decreasing trend above downward. P/C ratio and APPD showed a parallel trend with ICC-LC distribution, whereas split renal function (SRF) showed an inverse relationship with the expression of ICC-LC. Children with lesser severity of obstruction (APPD <30 mm and SRF >40%) showed a uniform decreasing trend in the number of CD117-positive ICC-LC across PUJ. Children with more severe obstruction (APPD >30 mm and SRF <40%) showed a decrease in the expression of ICC-LC up to the level of PUJO followed by a sudden relatively increased expression of ICC-LC below the obstruction.

Conclusion:

The expression of ICC-LC shows a uniformly decreasing trend across obstruction when the severity of obstruction is less. Resurgence in the number of ICC-LC below PUJ in subjects with severe obstruction hints at the emergence of a new pacemaker area below severely blocked PUJ akin to that seen in complete heart block patients and deserves early attention.
Preoperative Triple-Phase Three-Dimensional-Multi-Detector Computed Tomography Imaging of the Hepatic Vascular Tree
Authors: Mitra Aparajita , Bhatnagar Veereshwar , Agarwala Sandeep , Gupta Arun Kumar , Jana Manisha , Srinivas M. , Dhua Anjan Kumar
Published: September 2023

Objective:

To evaluate the hepatic vasculature/tumor relations in hepatoblastoma patients with three-dimensional (3D) reformatted images after triple-phase multi-detector computed tomography (MDCT) and to compare these with the surgical findings to judge the accuracy of this investigation.

Materials and Methods:

The study was carried out in hepatoblastoma patients after appropriate neo-adjuvant chemotherapy, prior to resection. Images were postprocessed at a dedicated workstation for multi-planar reformations, maximum intensity projection, curved planar reformations, and volume-rendered technique reconstructions. The reporting was done as per a specific protocol by both the radiologist and surgeon (per-operative findings) and the accuracy of MDCT ascertained as per concordance between the surgical and imaging findings.

Results:

Fourteen children (13 boys, 1 girl) underwent surgery. Clinically, relevant information regarding vascular, tumor involvement, and interface with vessels was provided by the study in all cases. Although all tumors were deemed resectable on preoperative imaging, one procedure was abandoned due to an unanticipated portal cavernoma. While a few anatomical variations were unexpectedly encountered during surgery, there was good concordance overall between findings on imaging and surgical exploration.

Conclusions:

MDCT with 3D reformatting provides accurate virtual representations of the hepatic tumor. This allows simulation of surgical resection with decreased risk of vascular injury and postoperative liver failure.
Long Tubular Duplication of the Small Intestine – Lessons Learnt from a Common Presentation of a Rare Disease
Authors: Vaze Poonam Guha , Acharyya Bhaswati C. , Banerjee Rupa , Biswas Somak Krishna , Chattpopadhyay Anindya , Saha Subhasis
Published: September 2023

Long tubular duplication of the small intestine is one of the most difficult surgical challenges. The presence of heterotopic gastric mucosa necessitates resection of the duplicated bowel, but shared vascularity with the normal adjoining bowel makes the task daunting. We present a case of long tubular small intestinal duplication with certain special surgical and perioperative challenges which were successfully managed.
Management of Umbilical Hernia in African Children
Authors: Ngom Gabriel , Zeng Florent Tshibwid A. , Sagna Aloise , Gueye Doudou , Ndoye Ndeye Aby , Mbaye Papa Alassane , Ndiaye Cheikh , Fall Mbaye , Ndour Oumar
Published: September 2023

Aims:

Umbilical hernia (UH) is common in African and African-descent children. In high-income countries (HICs), it is considered benign, which is not the case in Sub-Saharan ones. Through this study, we aimed to share our experience.

Materials and Methods:

A descriptive review was conducted from January 01, 2012 to December 31, 2017 at Albert Royer National Children's Hospital Center. Among the 2499 patients, 2146 cases were included in the review.

Results:

UH had a frequency of 6.5%, with patients having a mean age of 2.6 years, with a male preponderance of 63%. Emergency consultation occurred in 37.1%. The symptomatic hernia was present in 90.9%. The congenital type was found in 96%, a history of painful episodes was reported in 46%, and medical and surgical comorbidities were found in 30.1% and 16.4%, respectively. Multimodal anesthesia was used in 93.1%. A lower umbilical crease incision was made in 83.2%, the sac was not empty in 16.3%, and additional umbilicoplasty was performed in 16.3%. During a 14-month follow-up, a complication occurred in 6.5% and mortality in 0.05%.

Conclusion:

In our region, the pediatric UH was predominantly symptomatic, with its natural evolution leading to more complications than in HICs. Its management carried acceptable morbidity.
Propranolol for Vascular Anomalies
Authors: Gupta Rahul
Published: September 2023

Context:

Congenital vascular anomalies are classically subdivided into vascular tumors and vascular malformations. The role of propranolol in the regression of infantile hemangioma (IH), a vascular tumor, is well establishe.

Aims:

This study aimed to analyze the therapeutic efficacy and complications associated with oral propranolol and adjuvant therapy in the treatment of vascular anomalies.

Settings and Design:

A prospective interventional study was undertaken over 10 years duration extending from 2012 to 2022 at a tertiary care teaching institute.

Materials and Methods:

All children with cutaneous hemangiomas and lymphatic and venous malformations under 12 years of age, except those with contraindications for administration of propranolol, were included in the study.

Results:

Out of 382 patients, there were 159 males and 223 females (male: female = 1:1.4). The majority (53.66%) were between ≥3 months and 1 year. There were 481 lesions in 382 patients. There were 348 patients with IH, and 11 were congenital hemangiomas (CHs). There were 23 patients with vascular malformations; lymphatic malformation (n = 19) and venous malformation (n = 4) were present. The size of the lesions ranged from 5 mm to 20 cm; 50.73% were 2–5 cm in size. Ulceration (>5 mm) was the most common complication present in 20/382 (5.24%) patients. Complications related to oral propranolol were seen in 23 (6.02%) patients. Drugs were given for a mean period of 10 months (range from 5 months to 2 years). At the end of the study, 282 (81.03%) out of 348 patients with IH showed an excellent response; 4 (36.36%) patients in the case of CH (n = 11) and 5 (21.74%) patients with vascular malformation (n = 23) showed excellent response.

Conclusion:

The study validates the use of propranolol hydrochloride as the first-line agent for the treatment of IHs and congenital hemangiomas. It may have an additive role in lymphatic malformations, and venous malformations, as a part of a multimodality treatment approach for vascular malformations.
Assessment of Gastric Residual Volume with Ultrasound in Children at Fasting and after Oral Intake of Carbohydrate-Rich Fluid in the Preoperative Period
Authors: Garg Keshav Kumar , Agarwal Aarti , Goyal Puneet , Lal Hira , Prasad Raghunandan , Dhiraaj Sanjay , Pant Kailash Chandra , Lal Richa
Published: September 2023

Purpose:

Despite standard preoperative fasting guidelines, children are subjected to prolonged fasting due to various reasons. This does not reduce gastric residual volume (GRV) further, instead causes hypoglycemia, hypovolemia, and unnecessary discomfort. We calculated the cross-sectional area (CSA) of antrum and GRV in children in fasting state and 2 h after intake of oral carbohydrate-rich fluid, using gastric ultrasound.

Methods:

Anteroposterior and craniocaudal gastric antral diameters were measured by ultrasonography in the right lateral decubitus position, at fasting and at 2 h after 8 ml/kg of pulp-free fruit juice ingestion. CSA of antrum and GRV was calculated using validated mathematical models.

Results:

Data of 149 children of age >1–12 years were analyzed. Greater than ninety-nine percent of children emptied ≥95% of the ingested pulp-free fruit juice volume within 2 h. One hundred and seven (71.8%) children had reduced CSA and GRV at 2 h after fruit juice ingestion (2.01 ± 1.00 cm2 and 7.77 ± 6.81 ml) as compared to fasting state (3.18 ± 1.40 cm2 and 11.89 ± 7.80 ml). Fourty-nine (28.2%) children had slightly increased CSA and GRV at 2 h after fruit juice (2.46 ± 1.14 cm2 and 10.61 ± 7.26 ml) than at fasting (1.89 ± 0.92 cm2 and 8.61 ± 6.75 ml), but this increased GRV was grossly lower than limit of risk stomach (26.54 ± 8.95 ml).

Conclusion:

Carbohydrate-rich drink in the form of pulp-free fruit juice may be safely permitted up to 2 h before anesthetic induction, as it promoted gastric emptying in ≈ 72% of children and 28% of children, although GRV was slightly higher at 2 h after fruit juice ingestion than fasting but remained considerably lower than limit of risk stomach.
Role of Partial Splenectomy in Gaucher's Disease in Resource Challenged Nations
Authors: Santanakrishnan Ramesh , Dasaratha Vinupriya , Munianjanappa Narendra Babu , Javaregowda Deepak , Saroja Murali Govindappa
Published: September 2023

Context:

Gaucher's disease (GD) is a rare inherited metabolic disorder caused by the defective activity of glucocerebrosidase. Enzyme replacement therapy (ERT) and substrate reduction therapy are the treatment of choice. Total splenectomy has a role when the child develops complications of massive splenomegaly. There are only a few case series of partial splenectomy in GD in the pediatric age group.

Aims:

To study the role, technical feasibility, and challenges of partial splenectomy in children with GD with hypersplenism.

Materials and Methods:

Retrospective review of children of GD who had partial splenectomy between February 2016 and April 2018. Demographics, clinical findings, laboratory, operative details, transfusion requirements, and perioperative, immediate, and late complications were retrieved. Clinical courses after discharge were obtained from follow-up data.

Results:

Eight children with GD underwent partial splenectomy between 2016 and 2018. The median age at surgery was 3 years and 6 months (range −2 years to 8 years). Five children underwent partial splenectomy successfully, of which one child required postoperative ventilatory support for 48 h owing to lung atelectasis. Three children underwent completion splenectomy due to bleed from the cut surface of the splenic remnant. One of the children who underwent completion splenectomy expired on the postoperative day 5 due to refractory shock with multi-organ dysfunction.

Conclusion:

Partial splenectomy has a definite role in selected children who present with massive splenomegaly with mechanical effects and/or hypersplenism while awaiting ERT.
A Rare Case of True Pancreatic Cyst
Authors: Achugatla Sushma , Singh Surendra , Sharma Rahul Deo , Redkar Rajeev , Tampi Chandralekha S.
Published: September 2023

Pancreatic cysts can be true or pseudocysts. True pancreatic cysts in children are rare clinical entities. We present a 23-month-old boy with a cystic lesion in the distal body and tail of the pancreas which on histopathology was found to be a rare true congenital simple cyst of the pancreas.