bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroanatomy of Stroke: A Computed Tomography-based Topographic Analysis
Authors: Subhadarsini Sonali , Shani Aboobacker Sait , Mishra Dharma Niranjan
Published: May 2024

Background:

The present study is a computed tomography (CT)-based topographic analysis of cerebral stroke that constitutes the distribution of infarction and hemorrhage with respect to different neuro-anatomical structures. CT scanning is the easily affordable technique in India for the accurate diagnosis of cerebral stroke.

Aim:

The aim of the present study is to evaluate the incidence of brain stroke by CT scan in patients with cerebrovascular accidents.

Subjects and Methods:

Patients with cerebrovascular accidents were subjected to CT scan of the head using GE Revolution ACTs 16 slice multi-detector row CT scanners, slice thickness – 2 mm, 5 mm, and 10 mm and matrix size of 512 × 512. The incidence of stroke in patients over 20 years of age at SCB Medical College was evaluated during the period 2019–2021. The incidence of stroke was studied according to age, sex, and stroke subtype with arterial involvement.

Results:

The topography of brain infarction was highly variable with all regions of the middle cerebral artery (MCA) territory. There were 190 ischemic and 106 hemorrhagic stroke cases out of 296 patients. The mean age was 55.28 ± 12.73 years. Maximum stroke cases were seen in the age group of 41–60 years and 61–80 years of age. The most common site was basal ganglia 112 (37.83%) and common arterial involvement was MCA 161 (54.4%) with statistical significance (P < 0.05).

Conclusions:

The incidence of stroke rises with age and has its peak in the highly productive age group of 40–60 years of age. The findings of the present study will be helpful to young doctors for proper diagnosis and treatment.
The Stylohyoid Muscle Revisited: Anatomy and Clinical Implications
Authors: Lee Joo Won , Kim Soyeon , Sri Larnani , Dharma Muhammad Akira Takashi , Park Young-Seok
Published: May 2024

The stylohyoid muscle, one of the four suprahyoid muscles and one of the three styloid muscles, is a small thin muscle running from the styloid process to the hyoid bone. It is intimately related to the styloid process and the styloid ligament. It draws the hyoid bone superiorly and posteriorly along with the posterior belly of the digastric muscle. It functions mainly during swallowing and opening of the mandible. Clinically, it has received much attention for its association with Eagle’s syndrome. In this review, anatomic considerations with clinical implications of the stylohyoid muscle will be covered.
Morphometric Evaluation of the Human Corpus Callosum using Magnetic Resonance Imaging: Sex Difference and Relationship to Age and Intracranial Size
Authors: Tuncer Işik
Published: May 2024

Introduction:

The objective of this study was to determine the normal values of corpus callosum (CC) subregions in healthy adult individuals in our population using magnetic resonance imaging (MRI) and to reveal gender differences during normal aging.

Material and Methods:

We performed the measurements of certain CC dimensions in 104 (44 males and 60 females) individuals. MRI imaging device was used for the measurements. The subregions of CC were measured with the midsagittal images. After the measurements of CC and its sections’ (rostrum [R], genus [G], anterior body, posterior body, isthmus [I], and splenium [S]), length (L), width (W), and area (A) were carried out, the intracranial volume (ICV) and intracranial area (ICA) values were calculated. The Student’s t-test and Pearson correlation test were used for statistical analysis.

Results:

Morphometric data of length, width, area, ICV, and ICA were collected. No significant difference was identified in CC morphometry by age among the patients (P > 0.05). Indicating longer diameters in males, the differences between the genders were significant (P < 0.05). Moreover, the mean of R-L, G-A, and G-W measurements was found significant between the age groups (P < 0.001).

Conclusion:

Sexual dimorphism in the CC is not a simple artifact of sex differences in brain size and may reflect differences in connectivity necessitated by differences in brain sizes.
Consistent anatomical relationships of pedicle, lamina, and superior articulating process in severe idiopathic scoliosis allow for safe freehand pedicle screw placement: A proof-of-concept technical study
Authors: Dietz Nicholas , Spiessberger Alexander
Published: May 2024

Introduction:

Transpedicular screw placement has superior pullout strength compared to alternative forms of spinal fusion and is often performed in deformity correction surgery with navigation for optimal accuracy and reliability. Freehand technique for pedicle screws minimizes operation time and radiation exposure without fluoroscopy but is not widely adopted given the challenge of difficult anatomical corridors and accurate placement, especially in idiopathic scoliosis and advanced deformity. We used a computer-generated model to assess a proof-of-concept and anatomical feasibility of a freehand screw technique in severe scoliosis.

Methods:

Three-dimensional (3D) reconstructions of vertebra from a sample of two male patients with severe idiopathic scoliosis deformity (1 thoracic and 1 lumbar) with Cobb angles of 100° were used for planned placement of 17 levels of thoracolumbar (6.5 mm × 45 mm) pedicle screws. 3D reconstruction of each vertebra was created and measurements of screw entries and trajectories were reproduced with a 3D slicer software image computing platform.

Results:

Accurate transpedicular screw placement is possible with anatomical landmarks based on the 3D reconstructed vertebral levels. A series of 5 figures were assembled to demonstrate sagittal, coronal, and axial planes and key anatomical landmarks and trajectories of thoracic and lumbar freehand pedicle screws in severe idiopathic scoliosis.

Conclusions:

Anatomical landmarks for freehand transpedicular screw placement (between pedicle, lamina, and superior articulating process) are constant and reliable in severe idiopathic scoliosis as evidenced by 3D computer modeling. Preoperative computed tomography modeling may assist appropriate screw entry and trajectory based on anatomical landmarks for spine surgeons, and guide freehand technique for screw placement in adolescent idiopathic scoliosis.
Transdural retrieval of retropulsed transforaminal lumbar interbody fusion cages
Authors: Lefever Devon , Leveque Jean-Christophe , Hanks Thomas Allen , Sethi Rajiv K. , Eley Nicholas C.
Published: May 2024

Transforaminal lumbar interbody fusions (TLIFs) are performed for various lumbar spine pathologies. Posterior migration of an interbody cage is a complication that may result in neurologic injury and require reoperation. Sparse information exists regarding the safety and efficacy of a transdural approach for cage retrieval. We describe a surgical technique, in which centrally retropulsed cages were safely retrieved transdurally. A patient with prior L3-S1 posterior lumbar fusion and L4-S1 TLIFs presented with radiculopathy and weakness in dorsiflexion. Imaging revealed posterior central migration of TLIF cages causing compression of the traversing L5 nerve root. Cages were removed transdurally; the correction was performed with an all-posterior T10-pelvis fusion. Aside from temporary weakness in right-sided dorsiflexion, the patient experienced complete resolution in their radiculopathy and strength returned to its presurgical state by 3 months. The transdural approach for interbody removal can be safely performed and should be a tool in the spine surgeon’s armamentarium.
Study the Possibility of Creating Mucosal Valve Mechanism at Ureteric Orifice without Obstructing the Urine Outflow but Preventing the Urine Backflow into the Ureters
Authors: Tyagi Nirpex , Kureel Shiv , Gupta Archika , Singh Gurmeet , Rai Rahul , Pant Nitin
Published: May 2024

Objective:

To study the possibility of creating mucosal valve mechanism at ureteric orifice without obstructing the urine outflow but preventing the urine backflow into the ureters.

Materials and Methods:

Ethical waiver was obtained from the institutional ethical committee. Prospective experimental study was conducted on the post-mortem specimen of intact bladder with urethra and bilateral ureters retrieved from the already slaughtered lamb available in the meat market. Feeding tube inserted via urethral opening into the bladder lumen and bladder inflated with saline demonstrated no reflux of urine via transverse cut opening of ureters. Bladder lumen opened, ureteric orifices incised backwards to eliminate the obliquity. After closing the bladder opening, saline inflation test demonstrated bilateral reflux of saline via cut openings of bilateral ureters. Bladder was re-opened. The upper limb of horizontal U started 10 mm lateral and 8 mm above the refluxing ureteric orifice. Distal most curvature of horizontal U was kept 5 mm medial to ureteric orifice continuing along the lower limb of horizontal U terminating 10 mm lateral and 8 mm below the refluxing ureteric orifice, mucosal flaps from superior and inferior incision mobilized and edges joined to cover the ureteric orifice creating a flap valve mechanism. Influx of saline via cut end of ureters demonstrated no obstruction. Bladder was closed. Saline inflation test and contrast study demonstrated abolition of reflux on flap side and persistence of reflux on another side.

Results:

Five such experiments were conducted. On the side where the valve was created, Vesicoureteral reflux was abolished in four but in one minimal reflux still persisted.

Conclusion:

Creating a mucosal flap valve around the ureteric orifice can prevent reflux in 80% of cases without obstruction and without the necessity of ureteric mobilization or creating submucosal tunnel.
Comparison of High Spermatic Vessel Ligation and Low Spermatic Vessel Ligation in an Undescended Model of Rat Testis
Authors: Nagendla Murali Krishna , Jain Vishesh , Agarwala Sandeep , Srinivas M. , Sharma M. C. , Gupta Surabhi
Published: May 2024

Aims:

The aim of this study was to compare the immediate and long-term outcomes after high spermatic vessel ligation (HSVL) and low spermatic vessel ligation (LSVL) in a high undescended testis (UDT) model in rats.

Materials and Methods:

A prospective randomized controlled study was conducted on 24 male Wistar rats. The rats were randomly divided into three groups. Group A underwent a sham laparotomy and acted as the control. Group B underwent HSVL of both testicular vessels. Group C underwent LSVL of both testicular vessels. Each group was again subdivided into two subgroups. One sub-group underwent blood collection and testicular biopsy of both testes 24 h after the procedure to demonstrate immediate changes. Other subgroups underwent blood sample collection and testicular biopsy of both testes on day 50 following the procedure for hormonal changes and long-term changes.

Results:

All the testes in HSVL showed atrophy (100%) in the long term, whereas LSVL showed atrophy in 12.5% of testes, even though both groups showed adequate neovascularization. Testes in HSVL showed poor bleeding on incision at both 24 h and day 50. On histology, 75% of testes in HSVL showed complete necrosis, and 50% in LSVL showed partial necrosis at 24 h. On day 50, all the testes in HSVL (100%) showed complete necrosis with dystrophic calcification, whereas all the testes in LSVL showed normal histology with good maturation of seminiferous tubules. There was no significant difference in testosterone levels between both groups.

Conclusions:

Both immediate and long-term changes following LSVL showed an increase in blood flow to the testis after ligation through collaterals and reverses early ischemic changes to the testis. Given the higher testicular atrophic rate after HSVL, LSVL or at least low ligation can be preferred for the management of high intra-abdominal UDT.
Yolk sac tumor of the parotid gland in a child and its differentials
Authors: Jaiswal Riddhi , Agnihotri Swati
Published: May 2024

Yolk sac tumors (YST) (or endodermal sinus tumors) are rare neoplasms of germ cell origin that have been reported in gonadal sites (testis and ovary). Extragonadal YST are uncommon and are extremely rare in the extracranial head-and-neck regions. Here, we present a rare case of a 1-year-old male with isolated YST of the right parotid gland initially diagnosed as malignant epithelial neoplasm with possibilities of mucoepidermoid carcinoma and epithelial–myoepithelial carcinoma.
Correlation of urinary biomarkers (Interleukin-6, Transforming growth factor-β, E-Cadherin, and MCP-1) with conventional parameters of disease progression in patients of posterior urethral valves
Authors: Mittal Priyanka Garg , Samujh Ram , Peters Nitin James , Sharma Sadhna
Published: May 2024

Aims

Posterior urethral valves (PUV) are the leading cause of end-stage renal disease in boys. The study aimed to look at the ongoing renal damage and profibrotic activity by measuring the levels of Interleukin-6 (IL-6), Transforming growth factor-β (TGF-β), E-cadherin, and Monocyte Chemoattractant Protein-1 (MCP-1) and observing trends in subsequent follow-ups and at the same time correlating them with the established parameters of disease progression.

Materials and Methods:

This prospective study included 36 consecutive patients of PUV, managed over a period of 18 months. IL-6, TGF-β, E-cadherin, and MCP-1 were measured in urine samples at the time of admission, pre-fulguration and 3 months' and 9 months' post fulguration. The observed values were correlated with the conventional parameters used in clinical practice.

Results:

All the biomarkers showed statistically significant trends when these values were compared on admission, postoptimization and 3 months' and 9 months' postfulguration. None of the biomarkers showed a significant correlation with renal function tests. E-Cadherin and TGF-β showed a positive and a negative correlation with ultrasonography (USG) kidney, ureter, and bladder (KUB) respectively. E-Cadherin showed a positive correlation, whereas IL-6 and TGFβ showed negative correlation respectively with micturating cystourethrogram (MCUG). IL-6 showed statistically a significant negative correlation with dimercapto succinic acid (DMSA). MCP-1 did not show any significant correlation with USG KUB, MCUG and DMSA.

Conclusion:

This study concludes that E-Cadherin, IL-6, TGF-β can be promising urinary biomarkers for early detection of the ongoing renal damage in patients of PUV following valve fulguration. MCP-1 may have more complex interactions, with inflammatory markers; which warrants further research.
Novel coaxial technique of percutaneous nephrostomy in young children
Authors: Rangarajan Krithika , Pulappadi Vishnu Prasad , Goel Prabudh , Jana Manisha , Sharma Raju , Gamanagatti Shivanand , Bajpai Minu , Kandasamy Devasenathipathy
Published: May 2024

Aims

The conventional Seldinger and trocar techniques of percutaneous nephrostomy (PCN) have inherent limitations in infants and younger children. We studied the role of a novel coaxial technique of PCN in children under the age of 5 years in comparison to the conventional techniques.

Materials and Methods:

This was a single-center feasibility trial based on 24 consecutive patients (n = 24 kidneys) under the age of 5 years, conducted over 12 months, substratified into Group I (n = 10): PCN with conventional Seldinger (n = 2) and trocar (n = 8) techniques and Group II (n = 14): PCN with proposed coaxial technique. In the proposed technique, catheter was inserted through the bore of a 14-G needle. The observation parameters included successful placement of PCN into the renal pelvis with free drainage of urine, number of needle punctures, duration of procedure, need for fluoroscopy, and procedural complications.

Results:

Proposed technique was successful in all cases with single-needle puncture, while conventional techniques were successful in 8/10 (80%) cases with multiple needle punctures required in 3/10 (33.3%) cases (P = 0.163 and 0.059, respectively). Proposed technique was associated with lower median procedure time (6 min vs. 10.5 min; P < 0.001) and lower incidence of fluoroscopy use (0/14, 0% vs. 5/10, 50%; P = 0.006) than the conventional techniques. No complications were seen with either technique.

Conclusion:

The proposed coaxial technique is a feasible alternative to the conventional techniques of PCN in young children. It reduces the procedure time and the need for fluoroscopy in these patients.
Congenital midline cervical cleft – A case report on a rare anomaly of the neck
Authors: Vidhya Annapoorni C. S. , Varkey Sam
Published: May 2024

Congenital midline cervical cleft is a rare congenital anomaly of the neck of uncertain embryological origin, with around 205 cases reported in literature. We report the case of an 8-year-old girl who presented with the same anomaly.
Meconium Periorchitis is Amenable to Prompt Radiological Diagnosis
Authors: Ramaswamy Rajendran , Abdella Khairy , Hegab Samir Morsi
Published: May 2024

Scrotal swellings in neonates are very common. A 25-day-old male child had right-sided firm, nontender scrotal swelling. Ultrasound scan (USS) diagnosed as meconium periorchitis (MPO). At 70 days of age, repeat USS and plain abdominoscrotal radiograph confirmed MPO, and surgery was avoided. Radiological diagnosis and management of MPO are discussed.
Escobar syndrome with monodactyly
Authors: Karad Somnath , Ahmad Imran , Tripathi Sudhanshu , Ali Sheikh Sarfraz
Published: May 2024

Escobar syndrome (nonlethal type of multiple pterygium syndrome) is a very rare genetic disorder. The central manifestations of Escobar syndrome are the presence of multiple pterygia, fixed joint contractures, and characteristic facies. Here, we report a case of Escobar syndrome with additional features such as monodactyly and hypoplastic pectoralis muscle.
How we made exstrophy bladder continent and preserved the renal functions
Authors: Chatterjee Uday Sankar
Published: May 2024

Purpose

Crucial requirement of exstrophy bladder repair is to make patients continent as well as to preserve kidney functions. We analyzed our patients' data retrospectively to study their continence and to find out the justification behind continence and preservation of renal functions.

Patients and Methods:

We selected files of 18 fully continent patients from 52 patients operated. Eleven out of 18 patients were presented from beginning and 7 were referred after around 8 to 14 years, as incontinent bladder following good repair of bladder neck and posterior urethra. Eleven were operated with complete primary repair of exstrophy along with pubic osteotomy minimal and were kept on cystostomy track (CT) till augmentation to vent out vesical pressure. In seven patients, we did reduction of caliber of posterior urethra and bladder neck along with CT followed by augmentation after 6 months.

Results:

All 18 patients are maintaining dry period for 24 h. Two patients had enuresis but are manageable with partial fluid restriction from evening. Seventeen out of 18 patients are maintaining their renal functions.

Conclusion:

No tension abdominal wall closure with rectus muscle apposition is essential to preserve repaired bladder exstrophy. Osteotomy prevents lateral drag to overcome failure of whole reconstruction. Increased “systolic” vesical pressure from contraction of small bladder might destroy the mechanism of continence and renal functions. Hence, venting of vesical pressure through CT is obligatory till augmentation which is of necessity to be done as early as possible to create a low-pressure continent system.
Doxorubicin extravasation from a port-a-cath into pleural space in a young girl
Authors: Tom Alex , Joshi Jayatheerth , Golla Manoj Kumar , Lashkari Harsha Prasad
Published: May 2024

Extravasation of chemotherapeutic agents from a peripheral cannula is a known problem, and to prevent that, oncology units use central vein access with indwelling catheters such as port-a-cath or Hickman catheter. The intrapleural extravasation of chemotherapeutic agents is a rare event. We describe a 9-year-old girl with newly diagnosed Ewing's sarcoma of the left upper humerus receiving neoadjuvant chemotherapy through a newly inserted port-a-cath device. The patient developed tachypnea and right-sided chest pain on day 2 of chemotherapy. The radiological investigations confirmed the extravasation of doxorubicin into the pleural space. The surgical washout with chest-drain insertion was done, and we continued flushing with normal saline until the drain fluid became clear. She has completed neoadjuvant therapy. This case report shines light into scenarios where extravasation of anthracycline into the pleural cavity or thorax can be managed conservatively and in settings where dexrazoxane is unavailable without causing much delay in restarting the chemotherapy.
Management of Primary Thoracic Neuroblastic Tumors in Children
Authors: Shanmugam Vivek , Vinayagam N. Karpaga , Senthilnathan R.
Published: May 2024

Aims:

The mediastinum is the second common site of origin of pediatric neuroblastic tumors. Primary thoracic neuroblastoma (NB) is considered to be a site with favorable outcome and is reported to have a better prognosis than the other sites of origin. This is an observational study on our experience in the management of children with primary thoracic neuroblastic tumors.

Materials and Methods:

A retrospective observational review of the medical records of all the children treated for primary thoracic neuroblastic tumors including NB, ganglioneuroblastoma, and ganglioneuroma over a period of 8 years from January 2011 to December 2018 at our Institute was performed. We analyzed the factors including age, stage, histology, symptoms at presentation, surgical management, adjuvant treatment, and the 2-year survival of patients.

Results:

A total of 23 cases of primary thoracic neuroblastic tumors were identified during the study period. Ten patients had Stage III disease (43%), six had Stage IV (26%), four had Stage II, and three patients had Stage I. A total of four children (17%) died during the study period. A total of 13 children underwent complete excision of the tumor.

Conclusion:

In this retrospective review, we have observed that the mediastinal site of origin alone did not uniformly confer an excellent prognosis for all the patients. While the patients with lower stage tumors, favorable biological profile, and infants had excellent prognosis, in another small subset of patients with undifferentiated histology, the prognosis was guarded with an increased risk of recurrence. The clinical presentation with pleural effusion and compression of the airway at the time of presentation was associated with poor outcome.
Pathology and Surgical Management of Urinary Retention Manifesting After Anorectal Malformation Surgery
Authors: Arunachalam Pavai , Sen Sudipta , Sam Cenita J. , Backer Abu
Published: May 2024

Introduction:

Associated congenital anomalies, operative structural injury, and postoperative neurovesical dysfunction combine to cause urinary retention in children with a history of surgery for anorectal malformation (ARM).

Aim:

To study the presentation and management of urinary retention in patients with a history of ARM surgery.

Methodology:

Retrospective study.

Results and Discussion:

Twenty-five children presented with urinary retention with a history of ARM surgery performed elsewhere. There were 17 males (high – 14, intermediate – 2, and low – 1) and 8 females (cloaca). Sixteen children had an abnormal spine. Eight children had urethral injury (total transection – 3) and three had a large residual rectal stump. 41/48 renal units were dilated and 27 refluxing. Seventeen children had abnormal estimated glomerular filtration rate and five had undergone urinary diversion.

Management:

Definitive surgical management was individualized, the most pertinent consideration being whether normal voiding would be feasible or whether a continent low pressure urinary reservoir with clean intermittent catheterization (CIC) would be a safer option. Operative management included excision of the rectal stump (3), urethral reconstruction (2), bladder augmentation (17), Mitrofanoff port (22), bladder neck closure (2), and antireflux surgery (13). Follow-up estimated glomerular filtration rate had improved/normalized in all but two patients. HUN resolved/improved in all and 25/27 refluxing units ceased refluxing. All are socially continent with ten voiding normally and the rest on CIC.

Conclusion:

Urinary retention after ARM surgery is multifactorial and requires prompt recognition and possibly urinary diversion. Final reconstruction aims at achieving continence with safe upper tracts. Urethral voiding is possible in the selected cases.
Adrenocorticotropic Hormone-Independent Hypercortisolism Managed by Bilateral Retroperitoneoscopic Adrenalectomy
Authors: Zameer M. M. , Rao Sanjay , Vinay C. , D’Cruz Ashley
Published: May 2024

Bilateral adrenalectomy is the reference treatment for Cushing's syndrome related to adrenocorticotropic hormone-independent macronodular adrenal hyperplasia (AIMAH). We report a case of AIMAH managed by sequential retroperitoneoscopic adrenalectomy and review the literature of the same.
Ethics on the Learning Curve
Authors: Rao Sanjay
Published: May 2024

Advances in surgical techniques and technologies require surgeons to constantly retrain and adopt these into their practices. Until the surgeon gains proficiency in the new technique, he is said to be on the learning curve. During this time, the patient is at higher risk of adverse outcomes. This poses significant ethical challenges. Several factors impact the surgeon's decision-making and ability to obtain a truly informed consent. These factors include personal bias – both the surgeons and the patients, absence of high-quality evidence, and market forces. This paper describes the ethical dilemmas faced by surgeons as they adopt newer technologies into their practice. It suggests measures that can ensure that surgical progress does not happen at the cost of patient safety.
Hair Tourniquet of the Uvula
Authors: Dey Rahul , Zameer M M , Vinay C , Rao Sanjay
Published: May 2024

Hair tourniquet syndrome (HTS) is a condition, where a strand of hair encircles the base of an appendage. We report a rare case of HTS of the uvula and review relevant literature.
Oral Atenolol versus Propranolol in the Treatment of Infantile Hemangioma
Authors: Pattanshetti Swapnil Annasaheb , Mahalmani Vidya M , Sarma Phulen , Kaur Hardeep , Ali Md Mokkaram , Malik Muneer Abas , Peters Nitin James , Prajapat Manisha , Kumar Subodh , Medhi Bikash , Samujh Ram
Published: May 2024

Background:

Infantile hemangioma (IH) is the most common benign vascular tumor of infancy. Propranolol is considered first-line therapy for IH. However, it is associated with side effects. Therefore, there was a need for alternative therapy. Atenolol, a selective b1-blocker may be free from such side effects. Hence, the present study aims to develop a more accurate estimate of the safety and efficacy of atenolol compared to propranolol in the treatment of IH.

Methodology:

A search of various literature databases (PubMed, Embase, Ovid, Scopus, Cochrane Central, CINAHL, Web of Science, and Google Scholar) was done to identify studies which compared propranolol versus atenolol in the treatment of IH. The combined odds ratio along with corresponding 95% confidence intervals (CIs) were evaluated using a fixed-effects model.

Results:

A total of 300 articles were screened of which five studies including 116 patients in atenolol arm and 138 patients in the propranolol arm were analyzed. Atenolol was comparable to propranolol in terms of efficacy as no significant difference was seen between both the treatment arms in terms of hemangioma activity score (mean difference 0.25 [95% CI;[FIGURE DASH]0.21, 0.71]) and complete response (odds ratio [OR] =0.43; 95% CI; 0.17, 1.11; P = 0.08,). Atenolol therapy was better than propranolol in terms of safety, i.e., serious/potentially serious side effect, (OR = 0.11; 95% CI; 0.02, 0.51; P = 0.005) and wheezing/bronchial hyperreactivity (OR = 0.11; 95% CI; 0.02, 0.51; P = 0.005).

Conclusion:

The present meta-analysis provides evidence that atenolol has got a comparable efficacy and better safety profile with propranolol
The Syringe Technique for Ultrasound-Guided Hydrostatic Intussusception Reduction
Authors: Rai Sandeep , DCunha Aureen Ruby , ShreeRaghu R M , DSouza Neevan
Published: May 2024

Background:

Ultrasound-guided hydrostatic reduction (UGHR) is a well accepted and widely used method of paediatric intussusception reduction, with the saline drip technique being the most commonly employed.

Aims and Objectives:

In this study we aimed to assess the outcomes of a novel technique of UGHR.

Materials and Methods:

Data was obtained from a 15 year retrospective chart review of paediatric intussusceptions. Following resuscitation, UGHR was performed for uncomplicated intussusceptions using a 50cc syringe to infuse saline into the colon. It was performed in the ultrasound suite without sedation and time taken was monitored. A maximum of 3 attempts were done to achieve reduction.

Results:

UGHR was attempted in 66 of 93 intussusceptions. The commonest type of intussusception was ileo-colic(91%) and the commonest symptom was vomiting(70%). Surgery was performed only when there was shock, peritonitis or repeated failed reductions. The median time taken for reduction was 4.9 minutes. The overall success rate was 83% with 89% of these requiring only a single attempt. There were no deaths or procedure related complications.

Conclusions:

The syringe technique for intussusception reduction is a safe, effective, and time-saving technique. Additionally, it offers the advantages of simplicity and rapidity of reduction and in experienced hands may not require pressure monitoring
Outcome of Patients with Antenatally Diagnosed hydronephrosis with Respect to Postnatal Diagnosis and Need for Surgical Intervention
Authors: Sen Sandeep Singh , Menon Prema , Malik Muneer Abbas , Sodhi Kushaljit Singh
Published: May 2024

Aims:

This study aims to determine the etiology of antenatal hydronephrosis (ANH) and predict need for surgical intervention based on antenatal renal pelvis anteroposterior diameter (APD).

Materials and Methods:

Combined prospective and retrospective study (2012–2018) of ANH cases with postnatal follow-up. Surgical intervention was correlated with the degree of hydronephrosis (HDN) and pelvis APD measured at the 2nd trimester, 3rd trimester, and postnatal 6-week follow-up.

Results:

One hundred and sixty-five patients were studied with a total of 219 ANH units. Transient HDN was seen in 116 units. Surgical intervention included pyeloplasty (n = 76), sub ureteric dextranomer injection (n = 8) and nephrectomy (n = 1). Chances of requiring surgery based on the degree of HDN in 2nd and 3rd trimester respectively were mild: 11.32% and 9.52%, moderate: 34.21% and 37.03% and severe: 85.71% and 86.27%. The mean increase in APD between the 2nd and 3rd trimester (n = 50) was lesser in conservatively managed (3.548 ± 4.219 mm) than surgically managed (8.261 ± 5.857 mm) patients (P = 0.002). In another subset (n = 37), the mean increase in APD between the 2nd trimester and postnatal period was less in conservatively managed (1.432 ± 0.612 mm) (P = 0.088) than surgically managed patients (12.91 ± 3.247 mm) (P = 0.004). The area under the receiver operating characteristic (ROC) curve showed that an APD of 8.2 mm in the 2nd trimester and 12.85 mm in the 3rd trimester correlated with the requirement of postnatal surgery.

Conclusion:

Apart from the degree of HDN, significant changes in APD between 2nd and 3rd trimester and cut off value suggested by the ROC curve will help during antenatal counseling with regard to requirement of postnatal surgery.
Thoracic Tumors in Children and their Long-Term Outcomes
Authors: Patil Neehar , Kadamba Padmalatha S. , Somashekhar Manjiri , Shetty Jeevak , Rama Somashekar A.
Published: May 2024

Aims:

This study aims to review our experience in children with thoracic tumors managed by different surgical approaches, and to evaluate their long-term outcomes in relation to their functional status and quality of life.

Subjects and Methods:

This is a retrospective study (2011–2021). Children <18 years with tumors of the thorax (lung, mediastinum, and thoracic cage) were included. All included were diagnosed, managed, and followed up based on a departmental protocol. Children alive were followed up annually to monitor the development of chest wall/spinal deformities and assessed regarding their quality of life (Lansky play-performance scale) and pulmonary functions. Information regarding their demography, clinical presentations, diagnosis, treatment administered, outcome, and follow-up details were collated and analyzed.

Results:

Twenty-two children with thoracic tumors were included (2011–2021). Of which, 6/22 are benign and 16/22 are malignant lesions. About 14/22 children are alive on a regular follow-up until 2021, with a mean follow-up of 6 years (benign) and 6.25 years (malignant). About 3/22 children with malignant tumors requiring thoracotomy with rib resections developed scoliosis with a severely restrictive pattern on pulmonary functions, having a mild-to-moderate restriction of play on quality of life grading.

Conclusions:

Early follow-up of children who have undergone various surgical approaches for thoracic tumors based on the quality of life assessment and pulmonary function tests helps in planning early intervention if needed, especially in those who have undergone thoracotomy with rib resections, thereby improving their long-term functional status.
Successful Management of a Child with Bronchoesophageal Fistula Associated with Other Anomalies
Authors: Raghunath B. V. , Angadi Kavya , Gurudutt AV , Srinivas Nidhi , Manjunath L , Madhu SD
Published: May 2024

Bronchoesophageal fistulas (BEFs) are rare malformations characterized by abnormal communication between the bronchus and the esophagus. Herein, we report a successful management of a child with BEF discovered as an intraoperative surprise and associated with the short gut, annular pancreas, and disorder of intestinal fixation.
Pulmonary Actinomycosis in Children
Authors: Raj Prince , Shankar Raghu , Alawadi Mohamed Amin , Corbally Martin
Published: May 2024

Pulmonary actinomycosis is an extremely rare disease in children. The diagnosis is challenging as the clinical presentation and radiological investigations may be atypical. We report a case of a pulmonary lesion extending to the chest wall posing as a malignant lesion. Biopsy revealed colonies of Actinomyces. Antibiotic therapy resolved the mass. A rare diagnosis of pulmonary actinomycosis should be kept as a differential diagnosis of such a mass in children.
Evolution of Antenatally Diagnosed Bronchogenic Cyst in an Infant
Authors: Singh Anita , Mandelia Ankur , Kawdiya Apurva , Naranje Kirti , Nigam Neha
Published: May 2024

Bronchogenic cyst is one of the rare developmental lung conditions. Depending on the location, it can cause significant compression of the mediastinal structures, especially airways leading to atelectasis, emphysema, wheezing, and stridor. Computerized tomography helps in the confirmation of diagnosis. Surgery is definitive management. We present a case of bronchogenic cyst which presented as emphysema leading to respiratory emergency in an infant.
Effect of Cytomegalovirus Infection on Initial Presentation and Overall Prognosis of Biliary Atresia Patients
Authors: Vig Ayushi , Elhence Poonam , Rathod Kirtikumar J. , Nayak Shubhalaxmi , Jadhav Avinash Sukdev , Pathak Manish , Saxena Rahul , Sinha Arvind
Published: May 2024

Background and Aim:

Biliary atresia is known to have a multifactorial etiology and perinatal infection with hepatotropic viruses such as cytomegalovirus (CMV) is a probable trigger in a subset of patients. The aim of the current study is to evaluate the effects of CMV association of biliary atresia on the initial presentation of patients and their response to Kasai portoenterostomy.

Patients and Methods:

We conducted a retrospective, single-center study on 20 patients of biliary atresia and classified them into two groups based on their CMV immunoglobulin M (IgM) positivity. We compared the age of initial presentation, the liver biochemistry at presentation, immediate and delayed follow-up, rate of jaundice clearance following Kasai portoenterostomy, and histopathology of liver between the two groups. Data were reported in terms of means, and P < 0.05 was considered significant.

Results:

Out of 20 cases of biliary atresia, 60% (n = 12) were CMV IgM positive. Infants with CMV-positive status were noted to be older at presentation (88.5 days [65–150 days] vs. 83 days [45–160 days] P < 0.05) were more jaundiced at presentation (total bilirubin – 13.51 mg/dl [9.09–15.99 mg/dl] vs. 11.83 mg/dl [6.5–13.5 mg/dl] P < 0.05), had higher alkaline phosphatase (751.2 IU/L [387–1951 IU/L] vs. 621.75 IU/L [172–857 IU/L] P < 0.05), higher gamma-glutamyl transferase levels (505.58 IU/L [376–1127 IU/L] vs. 376.75 IU/L [186–624 IU/L] P < 0.05), and had higher incidence of splenomegaly. The rate of resolution of jaundice postKasai portoenterostomy was also evidently less in CMV-positive patients. Four out of 12 patients have bilirubin >2 mg/dl at a 6-month follow-up.

Conclusion:

CMV-associated biliary atresia patients have delayed initial presentation and impaired jaundice clearance postKasai portoenterostomy. The role of antiviral therapy should be studied in this subset of patients.
Jejunal Intramural Hematoma
Authors: Selvarajan Namasivayam , Singaravelu Ramesh , Reddy Muralinath Sankaranarayana , Kathirvelu Gopinathan , Unny Ashitha K , Tamizhvanan Vidhya
Published: May 2024

Jejunal intramural hematoma (JIH) is rare. A 5-year-old girl, a known attention-deficit hyperactivity disorder child with paraneoplastic symptoms, on imaging showed a suspicion of Jejunal intramural mass with internal bleeding. Laparotomy showed a JIH. Evacuation of hematoma and Histopathological Examination (HPE) ruled out tumor. Possible explanation of the manifestation is suggested.
A New Self-expanding, Large-caliber Ureteral Stent Applied for Bilateral Long-segment Ureteral Strictures — A Case Report
Authors: Hsu Hsuan-Yun , Tsao Chih-Wei
Published: May 2024

Urologists are experiencing difficulties managing ureteral strictures (US). Several treatment options have been used to treat US. Here, we present two patients with US. The first case is a 49-year-old woman with a history of squamous cell carcinoma of the cervix, status postlaparoscopy-assisted vaginal hysterectomy and radical parametrectomy, and bilateral pelvic lymph node dissection with recurrence. She regularly underwent double-J catheterization for bilateral US. The second case is a 66-year-old woman with a history of serious papillary adenocarcinoma of the endometrium, poststaging laparotomy with extrafascial hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic, common iliac, and para-aortic lymph node dissection + omentectomy. She regularly underwent double-J catheterization because of bilateral US. Allium stents have been used to treat US. Hydronephrosis improved in both patients. Renal function improved in one patient. A new self-expanding, large-caliber ureteral stent is another treatment option for patients requiring internal ureteral drainage.
Comparison of Demographic Profile and Psychological Problems Related to Coronavirus Disease 2019 Outbreak among the General Public (18 Years and Above) in a Northern State of India
Authors: Joseph Jaison , Pareek Bharat , Grover Sandeep , Sharma Sunita , Varkey Biji P. , Sehrawat Tamanna , Kumari Sarita , Parjapat Seema , Saini Sapna
Published: May 2024

Background:

The psychological impact of the general public during a pandemic is complex and incompletely understood. There is a dearth of studies reporting the psychological problems in the general public during the coronavirus disease 2019 (COVID-19) crisis in India, including a comparison as per demographic profile.

Materials and Methods:

An online survey was conducted from April 17, to May 1, 2020 using the principles of the snowball recruiting technique. The psychological problems of the potential study subjects were evaluated using the Hindi version of the Patient Health Questionnaire-4 (PHQ-4) scale. There were a total of 1826 responses, out of which 391 were excluded from the analysis.

Results:

The mean age of the subjects was 41.95 years (Median = 50, SD = 19.05, range: 18–86 years) and around 45% of respondents were with an age range of 18–39 years. The mean and standard deviation of the PHQ-4 was 1.81 (2.34), and the overall prevalence of psychological problems was 30% as per the cutoff of PHQ-4. The estimates of anxiety and depression among study subjects were 11% (158/1435) and 16.1% (232/1435), respectively. Younger age, female gender, unmarried, and rural residential status were significantly associated with increased psychological problems in this setting.

Conclusion:

The psychological response to the COVID-19 varies with sociodemographic status, and about one-third of the people reported having psychological problems in the early phase of the COVID-19 pandemic in this setting. There is a need to expand the mental health services to each stratum of the society with a focus to provide personalized care as per the sociodemographic profile.
Stress, Mental Health, and Resilience during the COVID-19 Pandemic Lockdown
Authors: Sahithya B. R. , Kashyap Rithvik S. , Roopesh B. N.
Published: May 2024

Background:

The recent COVID-19 pandemic has induced a considerable degree of fear, worry, and concern in the population at large. Drastic changes in daily lives as a result of lockdown may expose individuals to high stress levels, which might make them vulnerable to mental health issues. It is important to identify and understand these difficulties, which can help mental health professionals and policy makers address these issues.

Aim:

The present study aimed to screen mental health problems and to gain insight into resilience among Indians during the COVID-19 pandemic lockdown.

Materials and Methods:

The study was cross sectional, using online survey method. Sociodemographic datasheet, a self-designed questionnaire, Patient Health Questionnaire and Brief Resilience Scale were entered into Google Form, and was sent using E-mails and WhatsApp to the personal contacts of the investigators. The link was also posted in social media groups. The participants were requested to complete the survey and then forward the link to their contacts. Inclusion criteria laid for the study included English speaking males and females, 18 years or older, and living in India. A total of 348 individuals filled in the forms, of which 327 were complete and included for analysis.

Results:

Fifty percent of the participants surveyed had symptoms of common mental disorders. Thirty-three percent had elevated scores needing diagnostic evaluation for somatoform disorder, 33% for generalized anxiety disorder, and 35% for depression. 8% reported developing interpersonal difficulties with family members, 17% reported financial stress, 23.5% were worried about job loss, and 35% found the lockdown very stressful. Elevated scores on patient health questionnaire-somatic, anxiety, and depressive symptoms were associated with financial stressors, worries about job loss, and lockdown stress. Ten percent of the participants indicated a need to talk to psychologist, and 40% were not aware of tele counselling facilities. Higher resilience was associated with lower odds of developing psychiatric symptoms.

Conclusion:

The results offer preliminary data-based insight into the impact of the lockdown, and are suggestive of increased stress and mental health liabilities. Fostering resilience may be critical to prevent or reduce mental health problems in general population during the pandemic.
Systematic Review
Authors: Sarkar Siddharth , Tom Ashlyn , Das Sauvik , Bharadwaj Balaji , Ghosh Abhishek
Published: May 2024

Background and Aims:

Relapse is a major clinical concern in alcohol use disorders. The magnitude of the problem, poor access and availability of treatment, and changing social milieu placed India in a challenging position. This was a systematic review of Indian studies on rates and determinants of relapse to alcohol.

Methods:

Systematic search (January 1980–May 2020) was carried out on PubMed and Google Scholar to select studies that presented either rates or predictors (or both) to alcohol. Relapse was broadly defined based on the characterization in the included articles. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard for reporting systematic reviews.

Results:

Thirty-six studies were selected for the qualitative synthesis from the 68 studies. In the pooled sample of 2481 participants, the relapse rate ranged from 3.4% to 90%. The study duration varied from 1 to 36 months. Results suggested that the rates were overall higher in the observational than interventional studies and in studies from states with community prevalence of alcohol use >15% than in those <10%. There was significant heterogeneity among studies. Risk factors of relapse identified were demographic (e.g., younger age), psychological (e.g., craving), situational (e.g., peer influence), stressful life situations (e.g., financial problems), and family history of alcohol use.

Conclusion:

Relapse is likely in a substantial proportion of participants. Addressing the risk factors might help in delaying relapse. Future studies could concentrate on inclusive study design and robust methodology, to examine and understand the rates and risk factors of relapse.
Utilization of Telepsychiatry Network Services during COVID-19: A Retrospective Observational Study
Authors: Sidana Ajeet , Goel Vibha , Sharma Sanya , Kaur Gurneet
Published: May 2024

Background:

The impact of the COVID-19 pandemic on the mental health of the individuals and treatment seekers has been immense. Telepsychiatry services were thus undertaken to continue the availability of services and maintain follow-up to reduce in-person outpatient visits.

Aims and Objectives:

(1) To study the sociodemographic and clinical variables of telepsychiatry service users and (2) To assess the compliance to telepsychiatry services in outpatient practice during the COVID-19 pandemic.

Materials and Methods:

The case details including sociodemographic variables and clinical variables of telepsychiatry service users from June 1, 2020, to May 31, 2021, were collected from the telemedicine pro forma approved by the institute. A comparison was drawn between the diagnosis of individuals seeking psychiatric help for the first time and old follow-up patients. The overall improvement and number of follow-ups were also analyzed. The data collected were tabulated and analyzed as per coding system using statistical analysis system software.

Results:

The data were analyzed and were studied retrospectively for a total of 300 patients. More patients were in the age group of 18–30 years (35.7%), males (70.3%), and were from an urban background (87.3%). The predominant reason for consultation was renewal of prescriptions (53.66%). Patients with International Classification of Disease diagnoses of F10–19, F30–39, and F40–49 were proportionately high. The maximum number of patients were followed up on 3–6 occasions (49.16%). 86.6% of the patients showed a significant improvement.

Conclusion:

The study concludes that telepsychiatry is very useful as a mode of treatment and its significant role in the enrollment of new patients with mental health issues as well as continuing follow-up, especially when physical consultations are difficult.