bluuebunny/crossref_metadata_2025 huggingface dataset:
L’évaluation des universités comme symptôme des transformations universitaires
Authors: Waltzing Aline
Published: May 2024

Cet article propose d’observer les transformations universitaires des dernières décennies sous l’angle des pratiques dites d’« évaluation » des universités néerlandaises instaurées dans les années 1980 par et pour l’Association des universités néerlandaises (VSNU). Il s’agira de retracer la généalogie de la VSNU dans les années 1980 : les éléments de contexte, acteurs impliqués, projets réformateurs en cours, raisons de sa création, et son fonctionnement à ses débuts. L’enquête historique dans les archives de cette institution a permis de montrer que son activité principale lors de sa création et jusqu’à la fin des années 1990 a été de mettre sur pied un système d’évaluation des universités néerlandaises, de leurs activités d’enseignement et de recherche. Par leur genèse, leur raison d’être, leur fonctionnement et leurs visées, les pratiques mises en œuvre depuis les années 1980 tranchent cependant avec les régimes d’évaluation des universités plus récents et étudiés dans le cadre des transformations universitaires de type New Public Management depuis les années 2000 : saisir les basculements dans les institutions et les pratiques d’évaluation elles-mêmes permet d’observer ces transformations dans l’une de leurs dimensions concrètes.
Ecological Footprint and Its Enhancing Factors in SAARC Countries
Authors: Singh Ajay Kumar , Singh Ravindra , Singh Santosh
Published: May 2024

High economic development is caused to increase ecological footprint (EF). Increasing EF creates an impediment for sustainable development. Previous studies applied several methods and indicators to examine EF in different countries. However, very few studies could examine the originating factors of EF using empirical models. Hence, this chapter measures EF for SAARC countries during 2000 – 2022. It explains the comparative performance of SAARC countries in EF using a time trend analysis. Thereupon, it also examines the impact of certain indicators on EF in SAARC countries using robust empirical analysis. There seems to be significant diversity in EF due to disparity in economic development and its enhancing factors in SAARC countries. EF increases as industrialization, greenhouse gas, inflation, GDP per person employed and age dependency ratio increase. Digitalization, renewable energy consumption, technological change and life expectancy rate showed a negative impact on EF.
Review of the Literature on Using Machine and Deep Learning Techniques to Improve IoT Security
Authors: Khang Alex , Singh Yudhvir , Barak Dheerdhwaj
Published: May 2024

The current work discusses the concept of the internet of things (IoT) and its implications on various domains, highlighting the challenges and security concerns associated with its expansive scope. This review work emphasizes the need for comprehensive security solutions to address the complexities of IoT infrastructure, particularly in the context of emerging threats. This chapter also underscores the importance of integrating security, energy efficiency, software applications, and data analytics in IoT systems. It outlines the evolving landscape of IoT security, including the vulnerabilities and potential consequences of inadequate security measures. Additionally, authors address the intersection of security and privacy concerns within deep learning (DL) and machine learning (ML), discussing various strategies such as homomorphic encryption, differential privacy, trusted execution, and secure multiparty computing. It acknowledges the computational demands of these approaches and the ongoing search for globally harmonized solutions. Finally, authors conclude by highlighting the challenges and strategies in countering adversarial attacks in DL and ML, emphasizing the effectiveness of adversarial training and the multifaceted nature of defense mechanisms.
Structural and Biochemical Requirements for Secretory Component Interactions with Dimeric IgA
Authors: Kumar Bharathkar Sonya , Stadtmueller Beth M
Published: May 2024

Secretory (S) IgA is the predominant mucosal Ab that protects host epithelial barriers and promotes microbial homeostasis. SIgA production occurs when plasma cells assemble two copies of monomeric IgA and one joining chain (JC) to form dimeric (d) IgA, which is bound by the polymeric Ig receptor (pIgR) on the basolateral surface of epithelial cells and transcytosed to the apical surface. There, pIgR is proteolytically cleaved, releasing SIgA, a complex of the dIgA and the pIgR ectodomain, called the secretory component (SC). The pIgR’s five Ig-like domains (D1–D5) undergo a conformational change upon binding dIgA, ultimately contacting four IgA H chains and the JC in SIgA. In this study, we report structure-based mutational analysis combined with surface plasmon resonance binding assays that identify key residues in mouse SC D1 and D3 that mediate SC binding to dIgA. Residues in D1 CDR3 are likely to initiate binding, whereas residues that stabilize the D1–D3 interface are likely to promote the conformational change and stabilize the final SIgA structure. Additionally, we find that the JC’s three C-terminal residues play a limited role in dIgA assembly but a significant role in pIgR/SC binding to dIgA. Together, these results inform models for the intricate mechanisms underlying IgA transport across epithelia and functions in the mucosa.
Modeling Approach and Departure Noise of the Joby Aviation Aircraft
Authors:   Joby Aviation, Thai Austin , Bain Jeremy
Published: May 2024

A computational method for modeling approach and departure noise of electric vertical takeoff and landing (eVTOL) aircraft is validated using flight test measurements of the Joby Aviation aircraft. The methodology consists of performing high-fidelity computational fluid dynamics simulations to generate acoustic hemispheres that are used as input in a noise propagation software package. Three hemispheres were generated based on waypoints in an approach trajectory. A simulation of hover was conducted to generate a hover hemisphere. The effects of hemisphere resolution, terrain, and airframe acoustic shielding were explored. Overall, there is an overprediction of noise but the comparison with measured values improves as the model becomes more complete, indicating that the method is capturing the physics correctly. The same set of hemispheres was applied to a different approach trajectory and demonstrated similar results with reasonable agreement to measurements. However, application of the approach hemispheres to a departure trajectory resulted in a larger overprediction of noise due to the differences in the trim conditions.
Computational Acoustic Prediction on the Aerodynamic and Acoustic Rotorprop Test
Authors:   US Army CCDC AvMC, Jia Zhongqi , Lim Joon , Jain Rohit
Published: May 2024

This paper investigates the interactional aerodynamics and acoustics of three pusher propeller configurations from the Aerodynamic and Acoustic Rotorprop Test (AART), which were tested in the National Full-Scale Aerodynamics Complex (NFAC) 40- by 80-Foot Wind Tunnel at NASA Ames Research Center. The three CFD simulation models - isolated propeller, full-wing/propeller, and half-wing/propeller - are simulated using the multi-disciplinary rotorcraft simulation tool CREATE™-AV Helios. Unlike the previous work in which the acoustics were simulated using PSU-WOPWOP, in the current work, acoustic prediction is carried out using NASA's acoustic prediction software AARON/ANOPP2. No significant difference is found between the two acoustic solvers for all configurations. The current isolated propeller and full-wing/propeller simulations, which include the nacelle behind the propeller and the actual hub from the experiment, are compared with the previous simulations that had a notional hub and did not model the nacelle. The current and previous simulations show similar acoustic predictions, except that the presence of the nacelle induces additional high-frequency acoustic pressure oscillations but of small magnitudes. All simulations are also compared with measurements. While the full-wing/propeller simulations match well with the measurements, the isolated propeller and half-wing/propeller simulations show discrepancies. The half-wing/prop simulation overpredicts the overall sound pressure level up to 5 dB, which requires further investigations.
Noise Modeling of a Tilt-Rotor Air Taxi Configuration Utilizing a Hybrid Acoustic Analogy Approach
Authors:   Technical University of Munich, Baerens Teresa , Schmahl Michael , Hornung Mirko
Published: May 2024

Presented herein is a comprehensive workflow for the aeroacoustic analysis of a tilt-rotor air taxi during cruise and hover flight using high-fidelity numerical methods. Employing a hybrid approach, the near-field flow is resolved by an unsteady Reynolds-Averaged Navier-Stokes (URANS) solver, which is paired with a Ffowcs Williams-Hawkings (FW-H) acoustic solver to compute the far-field noise. Both impermeable and permeable FW-H integration surface approaches are incorporated. To balance computational resources and accuracy, the flow domain is halved, while the acoustic data is processed to reflect the full vehicle acoustics. Isolated acoustic contributions of each rotor are extracted, allowing the investigation into the impact of phase shifts on the acoustic signature of the vehicle. Spectral analysis, directivity maps, and noise hemispheres reveal the resolution of fundamental open rotor characteristics and amplified tonal interaction noise that can be linked to aeropropulsive phenomena. The introduction of phase shifts can lead to reduced noise levels and an unsymmetrical acoustic field development. A direct comparison of the results based on impermeable and permeable FW-H source surfaces shows general agreement on the directivity prediction but significant differences in noise levels, potentially due to numerical dissipation, grid settings and the symmetry boundary.
Understanding Takeoff and Landing Noise for Small Multirotor Vehicles
Authors:   The Pennsylvania State University, Chaudhary Rupak , Valente Vitor , Mukherjee Bhaskar , Jue Andrew , Brentner Kenneth , Greenwood Eric
Published: May 2024

Small multirotor vehicles, for example, designed for package delivery, are expected to operate in close proximity to populated areas, raising concerns about noise pollution. This study utilizes acoustic flight tests and computational modeling of an instrumented research hexacopter developed at Penn State to investigate noise generation during takeoff and landing maneuvers, considering varying flight path angles and vehicle speeds. Flight tests were conducted at Mid-State Regional Airport and corresponding predictions were made using the Penn State Noise Prediction System. The predicted vehicle states and noise levels are first validated against the flight test data. The validated model and flight test data are then utilized to study the noise emissions of the aircraft. Measurements and predictions of the acoustic characteristics of the vehicle are analyzed using conventional noise metrics, frequency content, and directivity features. Descent maneuvers are found to be noisier than climb maneuvers. Noise generation decreases with an increase in forward speed during both climb and descent and also with an increase in vertical speed during climb. However, during descent, noise generation increases with an increase in sink rate.
Single-Cell Landscape and a Macrophage Subset Enhancing Brown Adipocyte Function in Diabetes
Authors: Gu Junfei , Jin Jiajia , Ren Xiaoyu , Zhang Xinjie , Li Jiaxuan , Wang Xiaowei , Zhang Shucui , Yin Xianlun , Zhang Qunye , Wang Zhe
Published: May 2024

Background: Metabolic dysregulation is a hallmark of type 2 diabetes mellitus (T2DM), in which the abnormalities in brown adipose tissue (BAT) play important roles. However, the cellular composition and function of BAT as well as its pathological significance in diabetes remain incompletely understood. Our objective is to delineate the single-cell landscape of BAT-derived stromal vascular fraction (SVF) and their characteristic alterations in T2DM rats.Methods: T2DM was induced in rats by intraperitoneal injection of low-dose streptozotocin and high-fat diet feeding. Single-cell mRNA sequencing was then performed on BAT samples and compared to normal rats to characterize changes in T2DM rats. Subsequently, the importance of key cell subsets in T2DM was elucidated using various functional studies.Results: Almost all cell types in the BAT-derived SVF of T2DM rats exhibited enhanced inflammatory responses, increased angiogenesis, and disordered glucose and lipid metabolism. The multidirectional differentiation potential of adipose tissue-derived stem cells was also reduced. Moreover, macrophages played a pivotal role in intercellular crosstalk of BAT-derived SVF. A novel Rarres2+macrophage subset promoted the differentiation and metabolic function of brown adipocytes via adipose-immune crosstalk.Conclusion: BAT SVF exhibited strong heterogeneity in cellular composition and function and contributed to T2DM as a significant inflammation source, in which a novel macrophage subset was identified that can promote brown adipocyte function.
Serum Magnesium Levels Are Negatively Associated with Obesity and Abdominal Obesity in Type 2 Diabetes Mellitus: A Real-World Study
Authors: Xu Man-Rong , Wang Ai-Ping , Wang Yu-Jie , Lu Jun-Xi , Shen Li , Li Lian-Xi
Published: May 2024

Background: There remains controversy over the relationship between serum magnesium levels and obesity in type 2 diabetes mellitus (T2DM). Therefore, the aim of this study was to assess whether there is any association of serum magnesium levels with obesity and abdominal obesity in T2DM.Methods: This cross-sectional, real-world study was conducted in 8,010 patients with T2DM, which were stratified into quintiles according to serum magnesium levels. The clinical characteristics and the prevalence of obesity and abdominal obesity were compared across serum magnesium quintiles in T2DM. Regression analyses were used to evaluate the relationship of serum magnesium with obesity and abdominal obesity in T2DM (clinical trial registration number: ChiCTR1800015893).Results: After adjustment for age, sex, and duration of diabetes, the prevalence of obesity and abdominal obesity was significantly declined across magnesium quintiles (obesity: 51.3%, 50.8%, 48.9%, 45.3%, and 43.8%, respectively, P<0.001 for trend; abdominal obesity: 71.5%, 70.5%, 68.2%, 66.4%, and 64.5%, respectively, P=0.001 for trend). After controlling for confounders, there were clearly negative associations of serum magnesium levels and quintiles with obesity and abdominal obesity in T2DM. Moreover, C-reactive protein partly mediates the effect of serum magnesium on obesity and abdominal obesity (P=0.016 and P=0.004, respectively).Conclusion: The significantly negative relationship between serum magnesium and the risk of obesity and abdominal obesity was observed in T2DM. Furthermore, the independently negative association of serum magnesium with obesity may be explained by its anti-inflammatory functions. Serum magnesium levels may be applied to assess the risk of obesity and abdominal obesity in T2DM.
Efficacy of Willis covered stent of intracranial pseudoaneurysms in the internal carotid artery: A systematic review and meta-analysis
Authors: Lin Li , Xiang Shao-Wei , Sun Yan-Ling , Chen Yuan , Wu Zhe , Ning Zhi-Feng , Shen Ding-Wen , Sima Xue-Qin , Wen Qi-Qiang , Wei Gui-Lai , He Qing-Yong
Published: May 2024

Objective:

To evaluate the efficacy of a novel coated stent in the treatment of intracranial pseudoaneurysm.

Methods:

MEDLINE, EMBASE, and PubMed databases were searched for literature published between 1990 and April 2022 according to PRISMA guidelines. All studies with ≥10 patients reporting successful implantation of Willis covered stent, therapeutic effect, complications, and postoperative follow-up were included. The combined incidence and corresponding 95% confidence intervals were assessed using a generalized linear mixed method and random effects model.

Results:

Five studies (116 patients with pseudoaneurysms) were included. The experimental groups in the selected studies showed a combined technical success rate of 81.03% (OR=18.31, 95% CI=9.39-35.69, I
2=79%, P<0.001). Clinical follow-up showed that the complete cure rate was as high as 94.4% after the follow-up (OR=106.81, 95% CI=39.08-291.88, I
2=0%, P=0.71).

Conclusions:

Willis covered stent is feasible, safe, and effective in the treatment of intracranial pseudoaneurysm.
Current Issues of Gastro-Oesophageal Reflux Disease Surgical Treatment in Children
Authors: Akhparov Nurlan Nurkinovich , Boranbayeva Riza , Suleimanova Saule Bakhtyarovna , Temirkhanova Madina
Published: May 2024

Gastro-oesophageal reflux (GER) disease is one of the most common diseases amongst a wide range of chronic inflammatory diseases of the gastrointestinal tract in children of all ages, significantly impairing the quality of life of the child and posing a serious threat to the health of the patient. From 2008 to 2019, 134 patients aging from 6 months to 12 years were hospitalised at the Scientific Center for Pediatrics and Pediatric Surgery including 69 (51%) infants. Of them, 51 (38%) were the patients with persistent manifestations of regurgitation, despite an outpatient course of conservative therapy; 29 (22%) patients with recurrent reflux-associated pneumonia; also, 35 (26%) children with GER in the structure of the main pathology of the central nervous system, as well as 19 (14%) patients after surgery of the anastomosis of the oesophagus with its atresia. One hundred and seven (79.8%) patients underwent surgery. Nissen oesophagofundoplication was traditionally performed in 41 (38%) patients, in combination with Stamm gastrostomy in 14 (34%), with Mikulich pyloroplasty in 9 (22%) and in combination with gastrostomy and pyloroplasty in 12 (29%) children. Laparoscopic Nissen oesophagofundoplication was used in 16 (15%) cases. Thall oesophagofundoplication was performed in 48 (45%) patients, while in two (2%) cases, Boerema gastropexy was conducted. The immediate results were studied in all 107 patients. Complications in the form of gastric distress syndrome were revealed in four (3.7%) patients who did not undergo pyloroplasty, which in two (1.9%) cases required additional surgery of the stomach draining, whereas in the other two (1.9%) patients, the distress syndrome was stopped conservatively. A dumping syndrome was identified in two (1.9%) patients. Timely recognition of the pathological process, its nature and prevalence determines the indications for the use of various methods of operation, which are based on an individual approach to each patient.
Surgical Neonates with Coronavirus Infectious Disease-19 Infection
Authors: Kadian Yogender Singh , Ali Mokarram , Kumar Chandrodaya , Kajal Pradeep
Published: May 2024

Coronavirus infectious disease-19 (COVID-19) has caused serious threat to global health. With progression of time, more and more cases are being reported in paediatric age group. Management of COVID-19-positive neonates with surgical condition is challenging as apart from medical management of COVID-19-induced morbidities, they also require surgical intervention. Various guidelines have been proposed for the management of neonates with coronavirus infection and surgical pathologies. In this original article, we are sharing our experience in managing such neonates. We managed five neonates with different surgical pathologies who were positive for the coronavirus at the time of admission. They received medical management initially. Three of these five neonates were operated after they were negative for the virus. The remaining two patients were operated in positive state due to their condition requiring urgent surgical intervention. All the recommendations as per the COVID-19 protocol were followed. Four of these babies survived. One neonate with the diagnosis of gastroschisis expired during stay in designated COVID-19 neonatal intensive care unit. Authors conclude that COVID-19-positive status of neonates should not scare the health-care workers. COVID-19 positivity in neonates does not alter the outcome.
Age-of-Cessation of Lumbar Lordosis Development as an Assessment Parameter
Authors: Okpala Francis Osita
Published: May 2024

Background:

In managing paediatric spinal deformities, the currently-in-use growth maturity assessment parameters (clinical or radiological) are based mostly on Caucasian populations. They may be adequate for general treatment planning but may not accurately predict the remaining growth potential. Some therapies (e.g. growing rod distractions or growth modulation surgeries) require more accurate predictions of remaining growth potential and race-specific values. Lumbar lordosis (LL) development ceases at spinal bone maturity. The age-of-cessation seems a more accurate predictor of remaining spinal bone growth potential, compared to currently-in-use growth maturity assessment parameters, but is rarely included in the growth maturity assessment parameters.

Aims and Objectives:

As a predictor of remaining spinal growth potential, age-of-cessation of LL development (Race-specific of Black populations) was quantified.

Materials and Methods:

In archival normal lateral lumbosacral radiographs of patients of a tertiary hospital in South-East Nigeria, LL development across five age groups (Birth– 9, 10–15, 16–20, 21–25 and 26–30 years) was quantified with lumbosacral joint angle (LSJA) in 215 (110 males, 105 females), and lumbosacral angle (LSA) in 238 (119 males, 119 females). Data were analysed with IBM SPSS Statistics 23.0 (NY, USA). P ≤ 0.05 was considered statistically significant.

Results:

Both LSJA and LSA age groups’ mean values progressively increased with age, and plateaued at 21–25 years range, with LSJA mean of 23.4 ± 1.3 years, and LSA mean 23.5 ± 1.3 years; the means difference was insignificant (P = 0.680).

Conclusion:

With ageing, there is progressive increment, and later, cessation of LL. Age-of-cessation indirectly infers spinal-maturity-age, and could indirectly be an assessment parameter of spinal-maturity-status.
Bringing Specialist Paediatric Surgical Care to the Doorstep in Rural Ghana
Authors: Budde-Schwartzman Britta , Shwarzman Ori , Lakhoo Kokila , Owusu Frank
Published: May 2024

Background:

The contribution of paediatric surgical conditions to the total burden of disease in low- and middle-income countries (LMICs) has recently been highlighted and it is widely agreed that solutions are needed to provide access to safe and affordable surgery for these children.

Materials and Methods:

We present a simple, cost-effective model that brings paediatric surgery to the doorstep of remote areas and uses the existing health system structure in its entity to fulfil patients' needs. Mobile clinic teams whose members are integrated staff in affiliated mission hospitals reach out daily on a rotational basis to 10 health posts. The team receives continuous paediatric surgery education from a paediatric surgeon to diagnose and treat simple cases.

Results:

The catchment area of the Gye Nyame Mobile Clinic includes 832,984 inhabitants. From 2008 to 2019, 4362 children visited the mobile clinic with a median age of 4.41 years. Totally 4142 (95.0%) children could be treated in the health post, 150 (3.4%) children were taken to the affiliated missionary hospitals, 55 (1.3%) needed a third-level facility and 15 (0.3%) were taken to the traditional healers by the family. The common paediatric surgical diagnosis on outreach was deep soft-tissue infection/skin lesion for surgical treatment (672/23.8% children), followed by abdominal wall hernia/abdominal wall malformation (586/20.8% children) and gastrointestinal conditions (521/18.5%).

Conclusion:

This model of paediatric surgery mobile clinic includes capacity-building, task-sharing, outreach and proven 12-year sustainability. We recommend this model for paediatric surgery care in remote areas of LMIC's.
Efficacy of Fibrin Sealant as Waterproof Cover in Improving Outcome in Hypospadias Surgery
Authors: Shenoy Neha Sisodiya , Tiwari Charu , Gandhi Suraj , Kumbhar Vikrant , Joseph Vini , Basu Syamantak , Makan Apoorva , Shah Hemanshi
Published: May 2024

Background:

This prospective comparative study aims to assess the efficacy of fibrin sealant to improve outcomes in paediatric patients operated for hypospadias.

Materials and Methods:

Forty consecutive patients with hypospadias were randomised into two groups of twenty patients each. The first group underwent hypospadias repair, technique depending on the type of hypospadias, whereas in the second group, fibrin sealant was used to reinforce the urethroplasty. Assessment was done with respect to the type of hypospadias, type of repair done, operative time, immediate post-operative complications (early ooze and skin flap-related complications), intermediate complications (urethra-cutaneous fistula) and delayed post-operative complications (penile torsion and poor cosmetic outcome) at follow-up. We also compared the overall improvement in outcome among the two groups.

Results:

First Group: The mean operative time was 1 h and 45 min. Complications were seen in nine patients: Early ooze (n = 2); skin flap-related complications (n = 3); fistula (n = 7); poor cosmetic outcome (n = 7) and penile torsion (n = 4). Second Group (Fibrin Sealant): The mean operative time was 1 h and 30 min. Post-operative complications were observed in five patients: Coronal fistula (n = 3) and poor cosmetic outcome (n = 3). On comparing, the differences in outcomes of ooze, skin flap-related complications and torsion were found to be statistically significant with P < 0.05. The differences in the urethra-cutaneous fistula and cosmetic appearance were not found to be statistically significant. The difference in overall improvement in complications was found to be statistically significant.

Conclusion:

Fibrin sealant, when applied over the urethroplasty suture line as a waterproof cover, may help to improve the outcome in patients with hypospadias.
Predictive Factors of Post-laparoscopic Appendectomy Peritoneal Collection in Children and Adolescents with Complicated Appendicitis
Authors: Khirallah Mohammad Gharieb , Elsossuky Nagi Ebrahim , Ghazaly Mohamed
Published: May 2024

Introduction:

Intra-peritoneal collection (IPC) following laparoscopic appendectomy (LA) of complicated appendicitis in children is a serious complication. This is associated with a longer duration of hospital stay, more costs, and psychological upsets of both children and their parents. The aim of this study is to evaluate different factors that may affect the development of IPC following LA of complicated appendicitis.

Patients and Methods:

Seventy-five children were admitted with acute complicated appendicitis. All of them had LA between January 2016 and October 2020. The following variables were studied: patients' demographics, clinical findings, laboratory and imaging studies and operative parameters. Patients were divided according to their post-operative course into two groups; Group (A): patients with IPC (n = 19), Group (B): patients without IPC (n = 56). Potential risk factors for the development of post-operative IPC were identified by univariate and multivariate logistic regression analysis.

Results:

Nineteen cases (25.3%), out of 75 patients, presented with post-operative collection. Forty-seven (62.7%) patients were males, the overall median age was 11 (inter-quartile range [IQR] 10–13). The most significant operative variable was the operative time, which was significantly longer in Group A, 78 min (IQR 75–88) versus 56 (50–66), P = 0.001. The following variables were associated with an elevated incidence of post-operative IPC; age, body mass index, total leucocytic count (TLC), duration of symptoms, pediatric appendicitis score, pre-operative morbidity, being on medications, operative time, suction and irrigation or suction only and drain duration. In the multivariate model, TLC (odds ratios [OR]: 1.358, P 0.006), symptoms duration (OR: 2.051, P 0.012), morbidity (OR: 2.064, P 0.041) and operative time (OR: 2.631, P 0.039) were statistically significant and confirmed as being predictors of IPC post-LA in complicated appendicitis.

Conclusion:

Post-operative IPC is quite common after LA for complicated appendicitis. Increased TLC, prolonged symptoms duration, associated co-morbidity and operative time could be predictors of its occurrence. Improving general condition, surgical technique and reducing operative time help to reduce its incidence.
Congenital Right Diaphragmatic Defects
Authors: Aihole Jayalaxmi Shripati
Published: May 2024

Background:

The descriptive clinical study was conducted to analyse the clinical profile as well as the outcome of congenital right diaphragmatic defects among children including neonates in a tertiary care referral neonatal and paediatric centre in southern Karnataka, India.

Materials and Methods:

This retrospective and prospective observational clinical study was conducted from January 2005 to August 2019, over a period of 14.7 years in a tertiary care referral neonatal and paediatric centre. Clinical characteristics and risk factors of 33 children including neonates admitted and diagnosed with congenital right diaphragmatic defects were assessed both pre- and postoperatively. Neonates and children with acquired right diaphragmatic hernia defects and the left-sided diaphragmatic defects were not included in this clinical study.

Results:

For statistical as well as clinical analysis, 33 study subjects were grouped into four groups, depending on the pre-operative and intraoperative findings as well as on their final diagnosis. Group I comprised right congenital diaphragmatic hernia (RCDH) (n = 18), Group II comprised RCDH with sac (n = 6), the babies with diagnosis of right diaphragmatic eventration were included in Group III (n = 7), whereas babies with other right-sided diaphragmatic hernia defects diagnosis were included in Group IV (n = 2).

Conclusion:

Right-sided congenital diaphragmatic defects, though rare, do carry excellent survival if referred early and managed in a tertiary care neonatal and paediatric centre as that of left diaphragmatic defects.
Applicability of the Revised Trauma Score in Paediatric Patients Admitted to a South African Intensive Care Unit
Authors: Kuronen-Stewart Cameron , Patel Nirav , Gabler Tarryn , Khofi-Phiri Isabel , Nethathe Gladness Dakalo , Loveland Jerome
Published: May 2024

Context:

Revised Trauma Score (RTS) is a validated tool in assessing patients in a pre-hospital setting. There are limited data describing its potential use in guiding referral to intensive care.

Aims:

Trauma scoring systems require appropriate validation in a local setting before effective application. This work examines the applicability of RTS to a paediatric intensive care trauma population.

Settings and Design:

A retrospective record review of trauma patients admitted to the paediatric intensive care unit at Chris Hani Baragwanath Academic Hospital between 2011 and 2013 was performed.

Subjects and Methods:

The cohort was arbitrarily split into three subgroups based on RTS using the 33rd and 66th percentile values and groups compared. Outcome measures examined included mortality, age, gender, length of stay (LoS), duration of ventilation (DoV) and change in Glasgow Coma Scale (GCS) from admission to discharge.

Statistical Analysis Used:

Categorical values examined with Fisher's exact test. Non-categorical values examined with the Kruskal–Wallis and Dunn's multiple comparisons tests.

Results:

Of 919 children admitted, 165 admissions were secondary to trauma. Data necessary for calculation of RTS were available in 91 patients. The mean RTS was 5.3, 33rd percentile was 4.7 and 66th was 5.9. DoV (P = 0.0104) and LoS (P = 0.0395) were significantly different between intermediate- and low-risk groups as was change in GCS between low-risk and both other groups (P < 0.0001).

Conclusions:

RTS is not predictive of mortality between high-risk (RTS < 4.09) and low-risk patients (RTS > 5.67) in this population. It may be useful in predicting other outcomes such as DoV and LoS.
Manual Separation of Labial Synechiae
Authors: Dhaiban Manal Abdul Rahman , Chaudhary Muhammad Amjad
Published: May 2024

Background:

Labial synechiae is a fairly common gynaecological problem that occurs as a result of inflammation leading to fusion between the labia minora. Being in a developing country with limited resources and poor compliance of patients to prolonged treatments, we are faced with immense challenges in the management of these girls.

Aims:

We wanted to evaluate the efficacy and the cost-effectiveness of manual separation and topical antibiotics with perineal hygiene in the management of pre-pubertal girls with labial synechiae.

Materials and Methods:

Design: Prospective, non-randomised interventional study. Participant: Pre-pubertal girls presenting with the diagnosis of labial synechiae in the period from September 2015 to January 2018. Interventions: Manual separation followed by topical antibiotic ointment application for 1 week with local hygiene. Outcomes measure: Complete release of the synechiae and no recurrence up to 6 months.

Results:

Out of the total 55 patients, only 48 patients were included, their age ranged from 3 months to 7 years (mean 2.8 years). Almost half of our patients were asymptomatic, and other half had symptoms (urinary tract infection, dripping of urine and itching). Majority of our patients belong to low middle class status. We had 100% complete release of synechiae and no recurrence on 6 months follow-up.

Conclusion:

Manual separation followed by topical antibiotics is a cost-effective method of the treatment of labial synechiae with immediate response and low recurrence rate.
Diagnosis and Surgical Management of Children with Oesophageal Achalasia
Authors: Idrissa Salahoudine , Oumarou A. , Mahmoudi Abdelhalim , Elmadi Aziz , Khattala Khalid , Bouabdallah Youssef
Published: May 2024

Introduction:

Achalasia is a primary oesophageal motility disorder with unknown aetiology. The aim of this study was to evaluate our 10-year experience in the diagnostic process and surgical management of oesophageal achalasia (OA) in children.

Methods:

A retrospective review of all children (age: 0–15 years) treated for achalasia at the department of paediatric surgery from 2007 to 2016 was conducted. The demographics, presenting symptoms, associated diseases, diagnostic process, outcomes and complications were analysed.

Results:

Fourteen patients were identified, with a mean age of 5.2 years. There were eight female and six male patients. The most common symptom was chronic vomiting, in all patients (100%), followed by weight loss in 10 (71.4%), cough in 6 (42.9%), dysphagia in 5 (35.7%) and chest pain in 3 (21.4%). The mean duration of symptoms until diagnosis was 36.3 ± 29.1 months. Three patients underwent an open Heller myotomy (HM) and 11 laparoscopic HM (LHM) including three conversions. The reasons for conversion were mucosal perforation in two cases and liver bleeding in one patient. The mean operating time and the average length of postoperative stay in the patients of LHM group were, respectively, 2.0 ± 0.7 h and 4 ± 1.5 days. The mean follow-up was 43.2 months.

Conclusion:

The diagnosis of OA in children is based on clinical arguments and especially on the barium oesophagram findings. Laparoscopic myotomy is the most effective surgical approach in children.
Choledochal Cyst in Children in Dakar
Authors: Ndoye Ndèye Aby , Wellé Ibrahima Bocar , Cissé Lissoune , Guèye Doudou , Diouf Cheikh , Mbaye Pape Alassane , Lo Faty Balla , Seck Ndèye Fatou , Sagna Aloïse , Ndour Oumar , Ngom Gabriel
Published: May 2024

Context:

Choledochal cyst is a rare malformation that mainly affects girls.

Aims:

The aim of this work is to report the diagnostic, therapeutic and evolutionary aspects of bile duct cyst in children in Dakar.

Subjects and Methods:

we conducted a prospective monocentre descriptive study from 1 July, 2016, to 30 June, 2019, in the Pediatric Surgery Department of Albert Royer Children's Hospital in Dakar. The studied parameters featured clinical, biological, radiological, therapeutic and evolutionary data. Overall, ten patients, including eight girls and two boys, were selected.

Results:

Two patients presented the classic triple-syndrome complex featuring an abdominal pain, an abdominal mass and jaundice. Most of the patients presented a symptomatology associating abdominal pain and vomiting. Biological cholestasis syndrome was present in six cases and biological cytolysis syndrome in five cases. The abdominal ultrasound-computed tomography (CT) scan confirmed the diagnosis and helped to set the Todani classification with a predominance of Types 1 and 4. Surgical treatment by laparotomy consisted of total excision of the cyst followed by a Y-en-Roux hepatico-jejunal anastomosis in nine cases, whereas we performed a drainage of the cyst in one case. Two patients presented a morbidity of anastomotic suture release and evisceration and had a good outcome after surgical repair. There was no mortality.

Conclusions:

The diagnosis of choledochal cyst dilatation (CCD) can be suspected in the postnatal period on the basis of a gastro-intestinal symptomatology with or without associated to jaundice. The combination ultrasound-abdominal CT-scan helps set the diagnosis. The laparatomic approach always has its place for the management of CCD, especially in our context.
Is Application of Salt for 3 Days Locally is Sufficient to Treat Umbilical Granuloma?
Authors: Singh Anita , Naranje Kirti , Pandita Aakash , Upadhyaya Vijai D. , Kumar Basant , Upadhyaya Ashish Datta
Published: May 2024

Background:

The falling of Umbilical stump occurs by 7-15 days of age. The healing of umbilical stump may be complicated by Umbilical Granuloma. It is often treated by chemical cauterisation which require repeated applications and may lead to local or systemic complications. Common salt by way of its dessicative property may help in treatment of Umbilical Granuloma.

Objective:

The objective of the study is to assess the role of common salt application in umbilical granuloma.

Materials and Methods:

This is retrospective study over 3 years from a pediatric surgery unit in Northern India. The study subjects were infants less than 10 weeks of age who presented with umbilical granuloma. The method of salt application was 1 pinch of common salt for 1 hour twice a day for 3 consecutive days. The babies were assessed at day 5thfor resolution. The success was defined as thrice resolution after 3 cycles. The baseline demographic details were taken and the association of success of treatment was analyzed.

Results:

A total of 36 infants were given treatment in form of common salt application for treatment of umbilical granuloma. The success of around 96% and the cases which presented early responded well. Most of the cases resolved after 3 cycles of treatment.

Conclusion:

The common salt application is effective in treatment of granuloma without any side effects.
Congenital Sacrococcygeal Rhabdomyosarcoma
Authors: Inuganti Renuka Venkata , Boddapati Amulya , Mathi Atchyuta , Shaik Rizwana
Published: May 2024

Rhabdomyosarcoma (RMS) is one of the common malignant soft-tissue sarcomas affecting children. It originates from the embryonic mesenchyme precursor of striated muscle and is frequently seen in the head-and-neck region, genitourinary system and extremities. Occasionally, it arises from the retroperitoneum, biliary tract and abdomen and is rarely seen in the sacrococcygeal area. A 4-month-male child presented with a nodule over the sacrum. Based on histopathology and immunohistochemical marker studies, a final diagnosis of RMS was rendered. There was no evidence of any teratomatous elements.
Femoral Hernia in Children
Authors: Haggui Basma , Hidouri Saida , Ksia Amine , Mosbahi Sana , Messaoud Marwa , Sahnoun Lassaad , Mekki Mongi , Belghith Mohsen , Nouri Abdellatif
Published: May 2024

Background:

Femoral hernias are an uncommon groin pathology among pediatric patients. Therefore, they are frequently misdiagnosed. In the present study, we review our experience with this rare surgical entity during the past 25 years.

Methods:

The medical records of 19 patients who underwent 22 femoral hernia repairs between January 1994 and December 2019 were retrospectively analysed.

Results:

Patients' age ranged from 2 to 12 years (mean age was 5. 5 years) with an approximately equal sex ratio (10 girls/9 boys). There were three bilateral cases identified separately. They were discovered and managed at different times. All the children were referred with a groin lump, but the correct pre-operative diagnosis was made in only 13 cases (59%). In the remaining cases, four were identified intraoperatively following negative exploration for a supposed inguinal hernia. The other five were found to have a femoral hernia 1 month to 12 months after ipsilateral inguinal hernia repair. All patients underwent elective surgery. The femoral canal was closed using either Lytle or McVay procedure. Recurrence occurred in only one patient 2 months after initial repair.

Conclusion:

Femoral hernias are often misdiagnosed. Pre-operative diagnosis can be obtained through careful clinical assessment. In equivocal cases, ultrasonography and laparoscopy could be useful. A correct pre-operative diagnosis will lead to suitable treatment, thus avoiding unnecessary reoperations and their related complications.
Changing Trend in the Management of Omphalocoele in a Tertiary Hospital of a Middle-Income Country
Authors: Ogundoyin Olakayode Olaolu , Ajao Akinlabi Emmanuel
Published: May 2024

Background:

The peri-operative management of omphalocoele in low- and middle-income countries is challenging owing to non-availability of neonatal intensive care units and equipment needed for the care of this anomaly.

Aim:

This study examined our experience in the management of omphalocoele and compared the pattern and outcome with a similar study from the same centre conducted four decades ago.

Methods:

A retrospective study of neonates managed for omphalocoele from 2003 to 2017 (Group A) was performed. Their demographic characteristics, clinical presentation, management modality and outcome were obtained and statistical analysis was performed to determine the predictors of mortality. The findings were also compared with the findings of a similar study (Group B) published from this centre four decades ago from 1973 to 1978.

Results:

A total of 95 patients were managed in Group A and 33 in Group B. Their ages ranged from 1 to 15 days with a median age of 1 day and a median gestational age at birth of 37 weeks (range – 36–43 weeks) in Group A and 5–72 h in Group B. There were 54 (56.8%) boys and 41 (43.2%) girls in Group A and 17 (51.5%) boys and 16 (48.5%) girls in Group B. Rupture of the sac was observed in 18 (18.9%) patients in Group A and 13 (39.4%) in Group B. Operative management was adopted for 55 (57.9%) patients in Group A compared to 14 (42.4%) in Group B. Mortality was recorded in 16 (16.8%) patients in Group A and 16 (48.5%) in Group B. Following further analysis in Group A, management outcome was noted to be significantly associated with the state of the sac (P = 0.011), presence of associated sepsis (P = 0.002) at presentation and management modality (P = 0.048) with only associated sepsis independently predicting mortality.

Conclusion:

Although epidemiological trend and clinical presentation are still similar, management outcome has improved over the years.
Mastitis and Breast Abscess in Newborns and Infants
Authors: Bertrand Kpangni Ahua Jean , Rose Nandiolo Koné , Franck Lohourou Grah , Célestin Bénié Adoubs , Ibrahim Traoré , Constance Bony Ursula N’gouan
Published: May 2024

Introduction:

Mastitis and abscess of the newborn breast are serious infections. The objective of our study was to describe the epidemiological and therapeutic aspects of these infections in our context.

Materials and Methods:

This was a retrospective study from January 2017 to December 2019. We included all children aged ≤2 months admitted for mastitis or breast abscess. The variables studied were epidemiological and therapeutic.

Results:

We collected 34 files, i.e., 11.3 cases/year. The sex ratio was 0.5. The mean age was 16.3 ± 6.6 days. The mean time to the consultation was 3.7 ± 2.4 days. The parents had undertaken a massage in 79.4% of cases. It was mastitis in 12 cases and abscess in 21 cases. Treatment was surgical in 26 cases.

Conclusion:

This affection is frequent with a female predominance. Its management must be early. The proscription of breast massage would reduce its frequency.
Prevalence of Sickle Cell
Authors: Satam Neha , Patil V W , Garg Deepa , Marar Thankamani
Published: May 2024

Background:

Sickle cell disease (SCD) is a common and neglected inherited disorder in the Indian tribal and nontribal population. Prevalent in scheduled populations, these are socioeconomically disadvantaged communities. SCD pathogenesis is widely studied at national and international levels which are limited to pain episodes and vaso–occlusive crisis.

Objectives:

In the present study, we studied the prevalence of SCD in tribal and rural population from Palghar.

Materials and Methods:

Subjects from primary health centers of Palghar, Maharashtra, were included in this study. Informed written consent was obtained from the all subjects. The investigation was done by solubility test and high–performance liquid chromatography, along with complete blood count.

Results:

Population is divided into three groups: sickle cell homozygous (HbSS), sickle cell heterozygous (HbAS), and control (HbAA). In the sample size of 5000 subjects, 1% sample was found to be affected by SCD (HbSS) and 4.08% were sickle cell heterozygous (HbAS). Comparison among hemolytic events versus vaso–occlusive single events suggests that hemolytic events, pallor and yellow sclera, counted more than other single vaso–occlusive event. Detailed screening and awareness will be the key to early intervention to reduce morbidity and mortality due to SCD.

Conclusions:

As SCD is becoming an increasing health concern within India, identification and creating awareness is of paramount importance. In this pilot study, heterozygous and homozygous for the sickle cell gene were explained and it is clear that SCD is a major hemoglobinopathy among the tribal people of Palghar. Further in–depth study is necessary for a proper understanding of pathogenesis of SCD.
Study of Depression in People Living with HIV/AIDS Attending Antiretroviral Treatment Center
Authors: Bhure Bhagyashri S. , Ankushe Rajendra T.
Published: May 2024

Background:

Depression, being the most common neuropsychiatric complication of HIV, is also associated with increased healthcare utilization, decreased quality of life, and poor adherence to antiretroviral therapy (ART). Depression is a multidimensional disorder affected by a variety of biological, psychological, and social determinants, and this relation becomes more complicated in HIV patients. The current study therefore aimed to assess the prevalence of depression in adult people living with HIV/AIDS using Patient Health Questionnaire 12 (PHQ12) and to study the various sociodemographic factors and clinical variables associated with depression in adult people living with HIV/AIDS.

Materials and Methods:

A cross-sectional study was conducted at an ART center in a tertiary care hospital in HIV/AIDS patients of 20–60 years of age. Sociodemographic and clinical characteristics were studied, and PHQ12 was used to assess depression. The χ2 test was applied to test association among depression, sociodemographic variables, and clinical variables of study subjects.

Results and Conclusion:

Out of the 372 study subjects 169 (45.4%) suffered from depression. Female sex, nuclear family, rural residence, lowered socioeconomic class (lower middle and below), illiteracy, widowed person, and opportunistic infection were significantly associated with depression (P < 0.05) in people living with HIV/AIDS. There was no significant association between prevalence of depression and age group, religion, CD4 count, and WHO staging.