bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of clinical and radiological scores for evaluation of activity in patients having thyroid-associated orbitopathy: A prospective observational study
Authors: Singh Manpreet , Rana Neeti , Ahuja Chirag , Gupta Pankaj , Zadeng Zoramthara
Published: May 2024

Purpose:

To find a correlation between the clinical (vision–inflammation–strabismus–appearance [VISA] score) and radiological (apparent diffusion coefficient [ADC] values) scores for evaluating disease activity in patients with thyroid-associated orbitopathy.

Design:

A prospective comparative study.

Methods:

Our study was performed for consecutively diagnosed thyroid-associated orbitopathy (TAO) patients. Clinical evaluation included the VISA classification system with the basic thyroid workup. An inflammatory score of <4/8 was considered inactive and ≥4/8 as an active disease. Every included patient underwent a diffusion-weighted magnetic resonance imaging (DW-MRI) scan of the orbits. The orbital parameters evaluated on imaging included the proptosis, thickness, as well as the ADC values of extraocular muscles.

Results:

We studied 33 consecutive patients (23 females, 69.7%) with a mean age of 41.8 years. The majority (n = 27, 81.8%) were hyperthyroid, four were hypothyroid, and two were euthyroid. In the VISA classification, nine patients had active TAO (≥4/8 inflammation score), while 24 had inactive disease. There was a positive correlation between the inflammation score and ADC values of medial rectus (MR), inferior rectus (IR) and lateral rectus (LR). We had nine patients with inflammation scores ≥4. With receiver operating characteristic (ROC) curve analysis, we found that the ADC value of IR can predict disease activity with 68% sensitivity and MR-ADC can predict active TAO with 87% sensitivity.

Conclusion:

The ADC parameters of DW-MRI are objective and less operator dependent than the clinical TAO activity scores like VISA classification. A randomized control trial may provide robust data on this correlation.
A novel technique for extensive submacular hemorrhage using high-dose tissue plasminogen activator
Authors: Chauhan Khushboo , Narayanan Raja
Published: May 2024

Background:

Submacular hemorrhage (SMH) is a sight-threatening disorder. Choroidal neovascularization secondary to age-related macular degeneration, polypoidal choroidal vasculopathy, trauma, angioid streaks, and pathological myopia are a few important causes. The conventional treatment of massive SMH is vitrectomy with manual removal of the clot with extensive retinectomy with/without tissue plasminogen activator (tPA). The usual dose of subretinal tPA is 10–25 µg.

Purpose:

To describe a new surgical approach in a case of massive SMH with retinal detachment without retinectomy.

Synopsis:

In our case of near total hemorrhagic retinal detachment due to subretinal hemorrhage caused by trauma (road traffic accident), the patient presented with a visual acuity of counting fingers. Core vitrectomy was performed and posterior vitreous detachment was induced. The locations for retinotomy to inject and aspirate subretinal blood were selected at the maximum height of retinal elevation near the arcades. Recombinant tPA (10 µg/0.1 ml concentration; 0.3 ml injected in two locations) was injected subretinally with a 23-G soft tip cannula in the superotemporal and inferonasal quadrant causing subretinal bleb formation. Subsequently, the surgeon waited for approximately 20 min on the table for the liquefaction of the clot. The liquefied blood and tPA were drained with a silicone soft tip. Endolaser was performed at the retinotomy site and 1000cs silicone oil was injected. No signs of toxicity such as vitritis, vasculitis, or retinal necrosis were noted.

Highlights:

Our unique technique of high-dose intraoperative subretinal tPA (60 µg) is safe and helpful in rapid clot lysis and recovery of visual acuity. The patient gained a visual acuity of 20/80 from counting fingers after 1 month of surgery and 20/60 after silicone oil removal. A high dose of tPA aids in the immediate aspiration of blood from a small retinotomy. A 23-G soft tip was used instead of a 41-G subretinal cannula to inject a large quantity of subretinal tPA.

Video link:

https://youtu.be/JzZBDUfa3NA
Retinoblastoma – A comprehensive review, update and recent advances
Authors: Nag Adwaita , Khetan Vikas
Published: May 2024

Retinoblastoma is the most common pediatric ocular malignancy. It is triggered by a biallelic mutation in the RB1 gene or MYCN oncogene amplification. Retinoblastomas can be unilateral (60%–70%) or bilateral (30%–40%); bilateral tumors are always heritable and present at an earlier age as compared to unilateral ones (18–24 months vs. 36 months in India). High prevalence rates, delayed presentation, and inaccessibility to healthcare lead to worse outcomes in developing countries. The past few decades have seen a paradigm change in the treatment of retinoblastomas, shifting from enucleation and external beam radiotherapy to less aggressive modalities for eye salvage. Multimodality treatment is now the standard of care and includes intraarterial or intravenous chemotherapy along with focal consolidation therapies such as transpupillary thermotherapy, cryotherapy, and laser photocoagulation. Intravitreal and intracameral chemotherapy can help in controlling intraocular seeds. Advanced extraocular or metastatic tumors still have a poor prognosis. Genetic testing, counseling, and screening of at-risk family members must be incorporated as essential parts of management. A better understanding of the genetics and molecular basis of retinoblastoma has opened up the path for potential targeted therapy in the future. Novel recent advances such as liquid biopsy, prenatal diagnosis, prognostic biomarkers, tylectomy, and chemoplaque point to promising future directions.
Atypical acquired toxoplasmosis
Authors: Shakha  , Chawla Rohan , Sinha Ayushi , Meena Suneeta
Published: May 2024

A 33-year-old male presented with unilateral painless vision loss with a history of sub-tenon steroid for the same. The fundus showed an elevated focus of retinochoroiditis with vitritis. On investigating for the cause, polymerase chain reaction test on the anterior chamber tap was found to be positive for Toxoplasma. Such confusing and atypical cases usually produce a clinical dilemma and should be managed in a stepwise manner. Ancillary investigations usually provide a clue to the clinician and should be performed without any hesitation.
Factors associated with integration of people recovering from alcohol dependence syndrome with their family: An exploratory study
Authors: Rathee Anjali , Devi Yumnam Surbala , Gupta Sandhya , Mandal Piyali
Published: May 2024

Background:

Alcohol is the most commonly consumed psycho-active substance in India. People who use substances and are in recovery often face societal discrimination and rejection, such as difficulty in obtaining employment, poor support for treatment, and inter-personal rejection.

Aim:

To find out the factors affecting the integration of people recovering from alcohol dependence syndrome with their families.

Materials and Methods:

A cross-sectional observational study was conducted using a purposive sampling technique among 50 pairs of alcohol-dependent people and their family members. Data were collected using self-administered Family Adaptability and Cohesion Evaluation Scale (FACES IV package), Substance Abuse Self-Stigma Scale, Affiliate Stigma scale, and A Social Support Inventory for Successful Transition. Appropriate statistical tests were used to identify correlations.

Results:

A negative correlation (r = -0.313, P < 0.05) was found between affiliate stigma and integration, and a positive correlation (P < 0.05) was found between social support and integration. Alcohol-dependent people from Alcoholics Anonymous reported higher levels of perceived social support than those from a tertiary hospital (mean = 47.68 vs. 39.84, P < 0.05).

Conclusion:

Affiliate stigma negatively impacts people with alcohol dependence and contributes to increased opportunities for interventions to address stigma. Social support has a positive impact on family integration of alcohol-dependent people with Alcoholics Anonymous participants reporting higher levels of social support compared to tertiary hospital participants. Therefore, the findings of this study highlight the need to involve families more intensively to reduce affiliate stigma.
A comparative analysis of burden of care and coping styles between wives of monosubstance- and polysubstance-dependent men
Authors: Khadanga Poornima , Nadadgalli Gomati , Pawar Gaurav
Published: May 2024

Background:

Polysubstance dependence has emerged as a clinically distinct entity from monosubstance dependence, yet its impact on patients’ wives is understudied. Wives of substance-dependent men face a tremendous burden in their social lives, leading to faulty coping and burden of care. Comparative studies between monosubstances and polysubstances are lacking.

Aims:

This study compared the burden of care and coping styles between wives of monosubstance- and polysubstance-dependent men.

Materials and Methods:

A comparative analysis was performed between wives of 70 monosubstance-dependent and 70 polysubstance-dependent patients. The burden of care was assessed by the Burden Assessment Schedule (BAS), whereas coping styles were assessed using the Brief Coping Orientation to Problems Experienced (Brief COPE) Inventory.

Results:

Both groups faced a moderate burden of care, which was significantly higher in wives of polysubstance abusers as compared to monosubstance abusers (U = 366.50, P < 0.01). The difference was mainly seen in their impact on well-being and relationships with others. Avoidant coping was significantly higher in wives of polysubstance abusers (U = 341.00, P < 0.01), whereas emotion-focused and problem-solving coping styles were equally represented. Avoidant and problem-solving coping styles positively correlated with the burden of care (P < 0.01).

Conclusion:

The burden of care and avoidant coping strategies are higher in wives of polysubstance-dependent men. An increased burden of care is associated with increased use of both avoidant coping and problem-solving coping.
Social media use and emerging mental health issues
Authors: Ventriglio Antonio , Ricci Fabiana , Torales Julio , Castaldelli-Maia João Mauricio , Bener Abdulbari , Smith Alexander , Liebrenz Michael
Published: May 2024

Since its inception, social media has brought about numerous benefits, including higher levels of social connectedness, potential positive interactions, and greater access to information. Nonetheless, the excessive use of social media can lead to negative health outcomes, such as social anxiety, depression, low self-esteem, reduced sleep quality, and higher perceived stress. It has been argued that boredom and loneliness may be mediating factors between social media misuse and negative mental health effects, above all among youth and adolescents. Likewise, exposure to graphic imagery or misinformation on social media may also have deleterious implications for mental health. Taken together, this suggests a need for targeted studies on the relationship between social media and mental health, as well as the development of educational interventions for adolescents to share knowledge about the safe use of such tools. Mental health professionals should be adequately trained in identifying risk factors and treating the negative health outcomes that may result from social media. Specific strategies and guidelines should be adopted by social media companies aligned with international evidence from health agencies and experts in e-mental health.
Lipoid Pneumonia: Siphoning of Gasoline
Authors: Prakash Keerthi A. , Narasimhan Aarthi , Mehrin Riha
Published: May 2024

Lipoid pneumonia is a rare condition that accounts for 1%–2.5% of all pneumonia. There are two types – exogenous and endogenous. In recent days, exogenous lipoid pneumonia has been on an increasing trend due to the exponential use of vaping. Exogenous lipoid pneumonia usually presents with cough, fever, breathlessness, chest pain, and weight loss. Usually, it is a diagnosis of exclusion and the presence of lipid-laden macrophages is required for its diagnosis. Here, we present a case of lipoid pneumonia which showcased the importance of detailed clinical history elicitation, approach, and management of lipoid pneumonia.
Embryogenesis and Histogenesis of the Human Fetal Liver at Various Stages of Gestation
Authors: Bhadoria Pooja , Modi Kavita , Singh Brijendra , Chaturvedi Jaya , Chaturvedi Amarjyoti , Mahindrakar Bhavaniprasad
Published: May 2024

Background of Study:

To assess the prenatal development of the human liver at gestation ages (GAs) 12–36 weeks using microscopic parameters and their correlation to predict the GA. The observation of microscopic features such as Kupffer cells (KCs), hematopoietic activity, stellate cells, glycogen granules, central vein (CV), and portal triad (PT) carries immense importance for its use in the estimation of fetal GA, detection of anatomical variations, and identification of congenital anomalies concerning branches such as anatomy, surgery, forensic sciences, radiology, pediatrics, and phytopathology.

Materials and Methods:

The present study was conducted in the department of anatomy on 33 normal fetuses of GA 12–36 weeks and classified them into 5 groups as A (12–16 weeks), B (17–21 weeks), C (22–26 weeks), D (27–31 weeks), and E (32–36 weeks). The general parameters were measured. Slides were prepared as per standard protocol and observed under a light microscope.

Results:

Microscopic observation reveals CV and PT in 15 weeks, dominant hematopoiesis till 21 weeks and then declines gradually, KC in 16 weeks, sinusoids in 19 weeks, glycogen granules deposition from 36 weeks, and hepatic lobule and portal lobule appears at 31 weeks.

Conclusion:

The knowledge of morphological features with respect to gestational age is a reliable reference help to prevent misdiagnosis of various pathological conditions of the liver such as cirrhosis, hepatomegaly, fetal anemia, intrauterine growth retardation, and congenital anomalies.
A Morphological Study of Cadaveric Liver
Authors: Sar Mamata , Singh Sabita , Behera Sarita , Bara Dibya Prabha , Baa Jeneeta , Mishra Srikanta Kumar , Soy Arpita
Published: May 2024

Background:

Liver is anatomically divided into right, left, quadrate, and caudate lobes. Functionally, it is divided into four portal sectors by four branches of portal vein. Three hepatic veins lie between these sectors as intersectoral veins and these intersectoral plains are called portal fissures. Minor fissures like umbilical fissure, venous fissure, and Rouviere’s sulcus are visible clefts on the visceral surface of the liver. Morphological variations in size, shape, lobes, and fissures are frequently found during routine dissection. This study is focused mostly on the surgical anatomy of lobes and fissures relevant for hepatic surgery.

Materials and Methods:

This was a cross-sectional descriptive study conducted on 50 formalin-preserved specimens of liver. The details of morphological features of lobes and fissures were examined and compared with the findings of previous studies.

Results:

Out of 50 liver specimens studied, in 8% of cases left lobe and quadrate lobe and in 12% of cases caudate lobe were hypoplastic. Accessory liver lobes were found in 12% of cases, most of which were small except 2 cases of large tongue shaped projections of accessory lobes attached to the left lobe and 2 on the right lobe. Diaphragmatic sulci were found in 12% of cases and Rouviere’s sulcus in 64% of cases. Accessory fissures were also found in quadrate and caudate lobes in 24% and 22% of cases, respectively. Pons hepatis was found in 20% of cases.

Conclusion:

Awareness about prevalence of morphological variations of liver can help avoiding errors in diagnosis and unwanted complications during surgery.
Evaluation of the Ponticulus Posticus with Cone-beam Computed Tomography in a Turkish Population
Authors: Erdem Suheda , Gündüz Kaan , Kasap Pelin
Published: May 2024

Introduction:

The aim of this study was to investigate the incidence of ponticulus posticus (PP) in a sample population with cone-beam computed tomography (CBCT).

Materials and Methods:

The images of 1000 patients who were examined CBCT were analyzed retrospectively. The frequency of PP was evaluated. The presence of complete or partial PP in the atlas was examined on reformed sagittal cross-sectional images.

Results:

It was found that PP was detected in 250 patients (25%). When the prevalence of PP among gender was examined, it was found that 129 (24.2%) of 533 females and 121 (25.9%) of 467 males had PP. Complete PP was detected in 142 patients and partial PP was detected in a total of 151 patients.

Discussion and Conclusion:

In conclusion, PP is a common variation of the atlas. The increase in the frequency of complete PP and the decrease in the frequency of partial PP in older age groups suggested that there may be a correlation between age and PP formation.
Laparoscopic Gastrogastrostomy – An Alternative Procedure for Stenosis after Sleeve Gastrectomy
Authors: Mercado Melanie , Alhayo Sam , Talbot Michael
Published: May 2024

Introduction:

Reflux symptoms associated with stenosis after laparoscopic sleeve gastrectomy can occur secondary to anatomical abnormality including mechanical stenosis and axial deviation, commonly occurring mid-sleeve. Treatment options include endoscopic intervention, including dilatation, stenting, myotomy, and surgical revision, with Roux-en-Y gastric bypass (RYGB) being preferred by many. In this case series, we report six patients who have undergone laparoscopic gastrogastrostomy (GG) for gastric stenosis and propose this as a possible surgical alternative for appropriately selected patients with symptomatic angularis stenosis.

Patients and Methods:

Medical records for six patients who underwent laparoscopic GG for treatment of persistent reflux symptoms due to angularis stenosis were reviewed. All patients were preoperatively investigated with endoscopy and abdominal three-dimensional computed tomography. Hiatal hernia and esophageal dilation were excluded. After further consultation, patients proceeded to laparoscopic GG.

Results:

Complete resolution of symptoms was reported in three of six patients, with Visick score 1, while the other three reported significantly improved symptoms. Postoperative body mass index remained similar to prerevision baseline. There were no postoperative complications.

Conclusion:

Revision to RYGB is effective for stenosis and reflux but can be challenging with the potential for long-term nutritional deficiencies and surgical complications. For patients with angularis stenosis, laparoscopic GG is a simpler revisional procedure that has shown adequate initial outcomes with no short or anticipated long-term complications in this case series. Patients with persisting symptoms could undergo subsequent gastric bypass if needed.
Evaluation of surgically treated primary spinal cord tumors in a single Indian institution: A case series study of 178 patients
Authors: Jignesh Joshi K. , Balasubramaniam Srikant , Devendra Tyagi K. , Nakul Rathore R. , Monali Patil M. , Nadkarni Trimurti D
Published: May 2024

Introduction:

Primary spinal cord tumors are rare tumors that are usually heterogeneous having variable histopathological subtypes. Rapidly, growing space-occupying lesions in the spinal canal cause severe loss of function. This study aimed to analyze all adult patients diagnosed with primary spinal cord tumors and to describe their location, symptoms, histopathological types, surgical outcome, complications, recurrence in a single institution, and prognostic factors.

Materials and Methods:

The study was a retrospective study of 178 patients with spinal tumor who underwent surgical intervention at the department of neurosurgery at a tertiary care institute from 2014 to 2021. Patient demographic characteristics, symptoms, radiological features, spinal level of tumor, spinal compartment, preoperative and postoperative McCormick grade, and complications were recorded, and a comparison of outcomes after surgical intervention was done.

Results:

In our study, 97 patients were males and the rest of the 81 patients were females. The mean age at the time of surgery was 43.5 years. The thoracic region of the spinal canal was the most involved with 67 (37.64%) cases, whereas intradural extramedullary was the most common (65.73%). Schwannoma was the most common histopathological subtype (46.06%). Total excision was achieved in 154 cases. A total of 37 patients were in Grades 4 and 5 of modified McCormick’s grade preoperatively. However, postoperatively, there were only 17 patients in this group. Two patients with cervical intramedullary tumor expired in the postoperative period.

Conclusion:

Early surgical intervention with sound microneurosurgical skills gives good outcomes independent of the type and location of tumor. Better outcomes are seen in extradural tumors, early surgical intervention, tumors better amenable to total resection, and in patients with better preoperative neurological status.
The Diagnostic and Predictive Value of Biomarkers for Pulmonary Fibrosis in Patients with Coronavirus Disease 2019
Authors: Lv Jiapei , Liping Chen , Huaying Wang
Published: May 2024

Introduction:

In coronavirus disease 2019 (COVID-19), particularly in older people, dysregulated immune response and aberrant repair can result in varied severity secondary pulmonary fibrosis (PF). By detecting some indicators, the occurrence and prognosis of fibrosis can be measured, providing directions for COVID-19 treatment.

Methods:

The research study lasted for 3 months and involved 88 COVID-19 patients. According to the chest radiological examination, 47 (53.41%) individuals were found to have no PF, while 41 (46.59%) showed PF. Clinical data such as inflammation markers, imaging findings, blood gas analysis, and hospital stay length were collected.

Results:

With area under the curve values of 0.7413, 0.7741, and 0.7048, respectively, and the study of the receiver operating characteristic curve demonstrated that mucin 1 (MUC1), carcinoembryonic antigen (CEA), and CXC chemokine receptor 10 (CXCL10) could diagnose the presence of COVID-19 PF. To evaluate the possibility of PF following severe acute respiratory syndrome coronavirus-2 infection, we established particular values for MUC1, CEA, and CXCL10 (1.296 ng/ml, 4.315 ng/ml, and 32.77 ng/ml, respectively). The survival curve for hospital days indicated that the length of hospital stays positively correlated with these three factors (P < 0.01). Transforming growth factor-beta did not correlate significantly with the severity of COVID-19 or PF.

Conclusion:

The results of this study suggested that the MUC1, CEA, and CXCL10 can be employed to explore the severity of secondary PF in COVID-19.
Pediatric Malignant Sacrococcygeal Germ Cell Tumor with Intraspinal Extension
Authors: Maddileti Varunkumar , Gazula Suhasini
Published: May 2024

Aims:

The study aimed to evaluate the presentation, management, and outcome of patients of sacrococcygeal malignant germ cell tumors (SC-MGCTs) with intraspinal extension.

Materials and Methods:

Case records of all cases of SC-MGCT were reviewed to identify cases with intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms if any, and outcome.

Results:

Of the three cases of SC-MGT, two had intraspinal extension. One had Altman Type 3 disease and another had Altman Type 4 disease; both had Stage 4 disease. The intraspinal extension in both patients was detected on contrast computed tomography scan and magnetic resonance imaging. One patient had bladder and bowel incontinence. All the tumors responded to preoperative chemotherapy. Gross complete local resection could be achieved in all patients. Neurological recovery was complete. All were alive with no recurrence on follow-up.

Conclusions:

Malignant sacrococcygeal GCTs with intraspinal extension are rare and can be managed with neoadjuvant chemotherapy which obviates the need for extensive exploration for excision and has got good neurological and oncological prognosis.
Coexisting Cystic Lesions with Right-Sided Congenital Diaphragmatic Hernia in a Neonate
Authors: Nanda Debasish , Pradhan Antaryami
Published: May 2024

Diaphragmatic defects involving the right side of the diaphragm are less common but represent a distinct entity. The clinical presentation, management, and prognosis differ significantly from a left-sided defect. We report a case of a term neonate who was diagnosed to have a congenital diaphragmatic hernia during the third trimester of pregnancy, operated at 36 h of life and subsequently found to have an associated mediastinal cyst in 1st week of life.
Appendectomy in Management of Malrotation of Gut is it Necessary?
Authors: Sthapak Eti , Kanneganti Pujna , Upadhyaya Vijai Datta , Kumar Basant , Agarwal Nishant , Mishra Ashwini
Published: May 2024

Introduction:

Malrotation is a congenital anatomical anomaly that affects the normal positioning of the intestines. Traditional management of malrotation, as described by Ladd, consists of detorsion of the volvulus if present, division of Ladd's bands, widening of the mesenteric root, proper positioning of the small and large bowels, and a prophylactic appendectomy. This study was done to determine whether appendectomy should be an integral part of the Ladds procedure or if it can be avoided.

Materials and Methods:

This retrospective observational study was conducted in one pediatric surgical unit in the tertiary care center of North India. All the cases of malrotation of the gut managed from January 2008 to December 2018 were reviewed. The details of the patients were recovered from the electronic data recording system of the hospital and manual operation theater records. The cases that have a follow-up of <5 years were not included in the study. The details were charted in an Excel Sheet for the analysis. No statistical test was performed because there was no event in patients in whom prophylactic appendectomy was not done.

Results:

The data analysis revealed that a total of 66 malrotation patients were managed during this period, those who fulfilled the inclusion criteria. Among 66 cases included in the study, in 41 cases, prophylactic appendectomy was done, whereas in the rest 25, prophylactic appendectomy was not done. During the follow-up, none of the patients in whom the appendix was preserved presented with signs or symptoms related to appendicitis or any other complications.

Conclusion:

Ladds procedure without appendectomy can be performed in view of the potential use of the appendix in the future, and with the fact that in the current era of advanced medicine, appendicitis can be diagnosed early due to the advancement of imaging and better record keeping.
Allaying Pediatric Preoperative Anxiety, Where are we now? – A Nationwide Survey
Authors: Shah Shreya Bharat , Sinha Renu , Hussain Sana Yasmin , Kumar Amit , Gupta Anju
Published: May 2024

Background:

Preoperative anxiety (PA) in children is a common phenomenon associated with various negative patient outcomes. Allaying PA is accepted as a standard of care, but its use is not universal and often overlooked. This survey is designed to evaluate the nationwide current practice patterns and attitudes of anesthesiologists toward the practice of allaying PA in children.

Materials and Methods:

A questionnaire of 25 questions, including information on methods of relieving PA in children, reasons for noncompliance, and associated complications, was framed. It was circulated among members of the Indian Society of Anaesthesiologists through an online survey of Google Forms and manually.

Results:

Four hundred and fifty anesthesiologists were surveyed. Responses were predominantly from anesthesiologists practicing in medical colleges across the country. Although 97% of the surveyed respondents practiced anxiety-relieving strategies, only 37% used it consistently. Seventy-three percent of anesthesiologists practiced both pharmacological and nonpharmacological techniques. The most common reason for avoiding premedication was an anticipated difficult airway (88%). Inadequate sedation was a commonly reported problem. Ninety-five percent of participants felt that PA-relieving strategies should be integral to pediatric anesthesia practice. The most common reason for not following these practices was an inadequate hospital infrastructure (67%). Ninety-seven percent of the participants believed that more awareness is required on this crucial perioperative issue.

Conclusion:

Only 37% of the surveyed anesthesiologists consistently used some form of PA-relieving strategy and the practice varied widely. Further improvement and team approach involving anesthesiologists, surgeons, and nurses is required to ensure the quality of pediatric PA-relieving services and establish it as a standard of care.
Fifty Most Influential Articles on Anorectal Malformations
Authors: Dhua Anjan Kumar , Kumar Vipan , Mishra Ashwani Kumar , Jain Vishesh , Yadav Devendra , Bajpai Minu , Agarwala Sandeep , Goel Prabudh
Published: May 2024

Background:

With the global assimilation of “publish and perish” culture into institutional academics, there has been an exponential rise in the publication numbers. There are ~2500 PUBMED entries related to “anorectal malformation (ARM).” The young clinician in his pursuit to translate experimental research to bedside often finds himself lost “in the midst of plenty.” This bibliometric analysis has been conducted to codify the seminal work on ARM for future reference and pay tribute to the most impactful articles.

Materials and Methods:

Thomson Reuters Web of Science citation indexing database and research platform was used to retrieve the most cited articles in ARM using appropriate search strings. The characteristics (name of authors, the total number of authors, the title of publication, journal of publication, year of publication, etc.,) of the 50 top-cited articles were analyzed.

Results:

The analysis revealed that the Journal of Paediatric Surgery was leading the choice of journal for publication. While most of the publications originated from the United States of America, Alberto Pena was the most influential author. The most studied topic was on associated malformations, and the most common study design was cohort studies.

Conclusion:

The approach of citation analysis provided us an opportunity to retrieve the most influential articles on ARM. The trends in research in ARM have also been analyzed, spreading over five decades.
Male Genital Injuries in Infants Caused by the Bite of Pet Pups
Authors: Raina Pamposh , Sharma Girish Kumar , Barwal Kailash Chander , Kumar Manjeet , Chauhan Sanjeev
Published: May 2024

Injuries to male genitalia of infants due to bite of a pet pup are a rare occurrence. Few dog bite injuries to the genitalia of male infants have been reported, however, similar injuries have not been reported by the bite of pet puppies. Male genital injury in three male infants aged 8, 10, and 11 months, by the bite of pet puppies aged 1–2 months, ranged from avulsion of penile and part of scrotal skin with loss of both testes in case 1, a near circumferential laceration of penile skin at the base of penis with scrotal laceration in case 2, and laceration in mid penile shaft resulting in degloving and complete transaction of distal penile urethra with scrotal laceration in case 3. All these infants were appropriately managed surgically (case 1 and 3) and conservatively (case 2) and were given thorough toileting of wound, antibiotics, prophylaxis for tetanus and rabies. Some of these injuries may require complex surgical procedures to reconstruct the male genitalia. Timely management with aggressive intent and conserving the local tissue is the key to success. We describe a case series of injury to the external genitalia of three male infants by the bite of pet puppies, their possible predisposing factors, treatment, and follow-up. A case report and series like this have not been reported in literature so far to the best of our knowledge.
Evaluation of Complication Rates of Free Flap Reconstruction in Pediatric Patients
Authors: Allam Omar , Shah Rema , Cadwell Joshua B. , Dinis Jacob , Peck Connor , Junn Alexandra , Gowda Arvind , Alperovich Michael
Published: May 2024

Introduction:

While there is extensive literature investigating surgical outcomes in free flaps for adults, there is a dearth of information on the efficacy of flap use in the pediatric population. This study is the first to measure complication rates following pediatric free flap reconstruction on a national level.

Methods:

All pediatric free flap cases between 2012 and 2018 were identified and stratified by type of flap using current procedural terminology codes assigned to the primary procedure in the National Surgical Quality Improvement Program database. Each entry included the recipient location of the flap, postoperative complications, and demographics. Chi-square analysis was used to compare complication rates across various flap groupings. In addition, univariate and multivariate analyses were used to identify independent predictors of flap complications or failure.

Results:

Multivariate regression analysis demonstrated that compared to bone flaps, there is increased risk of nonbleeding complications in skin (Odds Ratio (OR) =7.7, P = 0.029), muscle (OR = 10.6, P = 0.012), and osteocutaneous flaps (OR = 10.8, P = 0.018). Flap of the trunk (OR = 40.9, P = 0.003) and upper extremities (OR = 32.9, P = 0.041) had a higher odds of bleeding complications compared to head-and-neck flaps. Regression analysis also showed that older age is associated with bleeding complications, with patients aged 5–11 years (OR = 38.5, P = 0.027) and 12–17 years (OR = 30.6, P = 0.038) having greater rates compared to patients under the age of 2. The pediatric flap reoperation rate was found to be 3.6%–4.7%, with the highest flap anastomotic complication rate in the head-and-neck region (6.9%–8.0%).

Conclusion:

Free flap reconstruction across flap type, anatomic location, and age ranges are safe and efficacious in the pediatric population.
Sequelae of Corrosive Injury in Children
Authors: Radhakrishna Veerabhadra , Kumar Nitin , Gadgade Bahubali Deepak , Vasudev Raghunath Bangalore , Alladi Anand
Published: May 2024

Aim:

This study aims to determine the sequelae of corrosive ingestion in children.

Methods:

A retrospective study was conducted in the Department of Pediatric Surgery at a Tertiary Center. The children presenting between January 2015 and December 2020 with a history of ingestion of caustic agents were included in the study.

Results:

A total of 26 children were included in the study. The children with suicidal attempts were significantly older than those who ingested the corrosive agents accidentally (14.2 ± 1.9 years vs. 6 ± 3.3 years; P < 0.01; Student's t-test). Sixteen (62%) children had esophageal strictures, 8 (31%) had pyloric strictures, and a child (4%) had both esophageal and gastric strictures. Eight (31%) children required an initial feeding jejunostomy and 6 (23%) required a feeding gastrostomy as they had significant weight loss on presentation. Eleven (65%) esophageal strictures responded to the dilatation regimen and are symptom-free on follow-up. Three (18%) children with esophageal stricture underwent esophageal replacement. Eight (31%) children had a pyloric stricture and all of them were treated with a modified Billroth I gastro-duodenostomy. The children who presented after 2 months were found to have a significantly increased need for esophageal replacement (3/9 vs. 0/17; P = 0.03; Fischer's exact test).

Conclusion:

The corrosive ingestion in children is associated with higher morbidity. The sequelae include esophageal and antro-pyloric strictures. A feeding gastrostomy or jejunostomy was required in more than half of the patients. The children presenting after 2 months of ingestion were associated with an increased need for esophageal replacement.
Type VI Choledochal Cyst – An Emerging Rare Entity (11th Pediatric Case of Type VI) with a Review of Literature
Authors: Sushma A , Redkar Rajeev , Sharma Rahul Deo , Singh Surendra , Thakur Sonia , George Asha Mary
Published: May 2024

Choledochal cysts (CCs) are abnormal dilatations of the biliary system. Usually, CCs are classified into five types. The sixth type (Type VI) is an emerging and rare type, reported the first case in 1991. We report this rare CC, Type VI seen in our experience for the first time. We have also reviewed the literature; only 26 cases of Type VI were found, including adults and children, ever since the first case has been reported in 1991. To the best of our knowledge, this is the 11th pediatric case report of a Type VI choledochal cyst.
Fibromatosis colli
Authors: Sabounji Salsabil Mohammad , Gueye Doudou , Fall Mbaye , Ndour Oumar , Ngom Gabriel
Published: May 2024

Aims

The aim is to identify the epidemiological, diagnostic, therapeutic, evolutionary aspects, and risk factors related to the occurrence of this condition.

Subjects and Methods:

It was a retrospective and descriptive study of a series of 26 cases of fibromatosis colli collected over a period of 3 years (from January 1, 2017 to December 31, 2019). We studied the following parameters: frequency, age, sex, delay of consultation, motive of consultation, gravidity, parity, type of delivery, notion of birth trauma, birth weight, examination findings, ultrasound results, type of treatment, and evolutionary modalities. The data were collected from patients' files. The analysis was done on Excel 2016.

Results:

The frequency was 6.5 cases/year. The mean age was 2.1 months. The average delay of consultation was 6.3 weeks. A notion of obstetrical trauma was found in 16 cases (61.5%). Primiparity was noted in 15 cases (57.5%). Associated torticollis was noted in 03 cases. Cervical ultrasonography was performed in all cases (n = 26/26) enabling diagnostic confirmation. Surveillance was the main treatment (84.6%). After a mean follow-up of 20.8 months, evolution was favorable in the majority of patients. The average time of complete regression of the mass was 3.8 months.

Conclusions:

Rare condition of the newborn and infant for which the diagnosis is clinical and the confirmation is based on ultrasound. The management is simple and based on surveillance. The evolution is most often toward spontaneous regression.
Dermoid Cyst of Tongue Masquerading as a Lingual Neurofibroma
Authors: Pattanaik Varsha , Palagani Revathi , Gharpure Vivek
Published: May 2024

Dermoid cysts of the tongue are rare lesions of the head-and-neck region with only 16 reported cases in the English literature to date. We describe a 5-year-old girl who presented with a swelling in her tongue. Imaging done earlier was reported as a neurofibroma. It turned out to be a dermoid cyst. This was the first such case at our institute and this article reviews the literature and describes the said case in detail.
Bilateral single-system ectopic ureter
Authors: Mulawkar Prashant Motiram , Tapre Parag Vijayrao , Maheshwari Pankaj N , Agrawal Sumeet Gopal , Panpaliya Giridhar Shivnarayan
Published: May 2024

Bilateral single-system ectopic ureter (BSSEU) is often associated with underdeveloped incompetent bladder neck; hence, to achieve continence, bladder neck reconstruction (BNR) is usually advocated with ureteric reimplantation. Presented here is a 14-year-old girl with BSSEU who achieved continence without BNR. An attempt is made to look at factors that could identify patients in whom BNR could be avoided.
Transcutaneous electrical nerve stimulation in management of neurogenic bladder secondary to spina bifida
Authors: Pattanshetti Swapnil , Mahajan Jai Kumar , Saxena Somya , Saxena Akshay
Published: May 2024

Aims

To assess the role of transcutaneous electrical nerve stimulation (TENS), alone or in combination with anticholinergic drugs in the management of neurogenic bladder (NB) in spina bifida (SB).

Materials and Methods:

All the consecutive patients, visiting outpatient clinic between July 2017 and December 2018, who were toilet trained and at least 1 year post-SB surgery with clinical and/or urodynamic evidence of NB, were included in the study. Out of 65 patients, 40 fulfilled the inclusion criteria and were randomised into: group A (ten patients, placebo TENS with anticholinergic agents), Group B (14 patients, TENS therapy with placebo medications) and Group C (16 patients, TENS therapy with anticholinergic medications). All the patients maintained a voiding diary and underwent assessment before and after the intervention. The study was approved by the Institutional Ethics Committee.

Results:

The presenting symptoms were urinary incontinence (100%), increased frequency (45%), straining during micturition (22.5%), urgency (22.5%), and hesitancy (30%). The demographic parameters were comparable in all the groups. After group specific intervention, the wet episodes/day significantly improved in Group C (P = 0.001). Similarly, the mean wet days/week also improved significantly in Group C (6.5–4.37 days/week, P = 0.01). Out of 40 patients, 29 had abnormal findings on ultrasonography before the start of the therapy. Following intervention, only two patients in Group C showed normalization of findings. On Urodynamic studies, detrusor pressure (Pdet max) decreased in all the groups; however, the patients in Group C, showed the maximum reduction (56.6 ± 11–30 ± 6.7 cm H2O). Similarly compliance (9.4 to 14.5 cm H2O, P = 0.02) and bladder capacity (68%–88% of EBC, P = 0.001) also improved significantly in Group C as compared to other 2 groups Overall, nine patients (Group A, B, and C = 1, 3, and five patients, respectively) showed detrusor instability, while post therapy, only one patient (Group B) had unstable bladder. Maximum decrease in postvoid residue (mean) was also observed in Group C (77–41 ml, P = 0.01).

Conclusions:

The application of TENS in NB secondary to SB is effective and its application led to improvement in symptoms, decrease in the wet episodes/day, maximum detrusor pressure, instability, bladder compliance, and capacity. TENS therapy in combination with anticholinergic agents had a better outcome as compared to monotherapy with either of the two modalities.
Concealed penile duplication – Presenting late
Authors: Reddy K Abishek , Chandrashekar Vinay , Rao Sanjay , D'cruz Ashley
Published: May 2024

We report a case of concealed penile duplication without many symptoms and normally looking external genitalia in a 10-year-old boy. He was evaluated with appropriate imaging and had successful surgical reconstruction of his genitalia with good cosmesis and functional outcome.
Case of Botryoid Rhabdomyosarcoma Mimicking Biliary Hydatid Disease
Authors: Akbar Suha Mohammad , Tudu Harish Chandra , Mohanty Subrat Kumar , Mishra Amaresh , Mohanty Sruti
Published: May 2024

Hepatobiliary rhabdomyosarcoma (RMS) is a soft tissue malignant musculoskeletal tumor of the biliary tract. It is rare tumor, mostly seen in children and mimics common benign biliary condition. Here, we present a case of 1 year 9 months child of biliary RMS who presented with obstructive jaundice and diagnosed after biopsy. This case highlights the unusual childhood malignancy of bile duct RMS in obstructive jaundice with atypical imaging findings.
Mortality prediction score for Hirschsprung's disease-associated enterocolitis
Authors: Shah Harooni Syed Asif , Prasad G R , Danda Gayatri Reddy , Naureen Mahera
Published: May 2024

INTRODUCTION

Enterocolitis associated with Hirschsprung's disease is a fatal and serious complication. Number of scoring systems are in vogue to grade the severity of Hirschsprung's disease associated with enterocolitis (HDAEC), but none of these scoring systems help predict mortality. Hence, we attempt to develop a mortality prediction model (MPM) for HDAEC.

Materials and Methods:

A retrospective analysis of all cases of HDAEC encountered was analyzed. We also used the parameters of Elhalaby et al. for data collection. A total number of 71 cases were analyzed with regard to mortality in relation to each parameter. Sensitivity and specificity were calculated by statistician, and based on these values, a scoring model was proposed. All those with predicted mortality were given score 2 and those who did not were given score 1.

Results:

A total score of more than 16 predicted mortality, a score of <10 predicted survival, and a score between 11 and 15 predicted survival with morbidity.

Conclusion:

A MPM for HDAEC is being proposed.
Acinar Cell Carcinoma of the Uncinate Process of the Pancreas in a Child Managed Sans Whipple's Procedure-a Rare Case Scenario
Authors: Goel Tanvi , Anand Sachit , Dhua Anjan Kumar , Kakkar Aanchal , Agarwala Sandeep , Bhatnagar Veereshwar
Published: May 2024

Acinar cell carcinoma (ACC) is a rare malignant tumor of the pancreas. A 10-year-old girl presented with a large tumor arising from the pancreatic head. Excision sans Whipple's procedure was performed. Histopathology revealed it as ACC. In the context of this case, this rare tumor is being reported to highlight that such tumors arising from the head of the pancreas can be managed successfully without always resorting to a Whipple's procedure.
Congenital Pseudodiphallia –A Rare Case Presentation
Authors: Mishra Amit Kumar , Anand Vijay , Kale Ravi
Published: May 2024

Diphallia (penile duplication) is a rare congenital malformation with an incidence of about 1 per 5–6 million newborns. The severity of diphallia varies from a small accessory penile-like tissue to complete true penile duplication with other deformities, usually involving the urogenital, gastrointestinal, and musculoskeletal systems. Pseudodiphallia, as a rare kind of diphallia, is characterized by a small accessory penile-like tissue without a normal penile anatomy structure. A 5.5-year-old male child was brought to the pediatric surgery outpatient department by the parents with complaint of difficulty in retracting the prepucial foreskin and the presence of some growth near the glans. There were no other complaints in specific. Clinical examination revealed foreskin retractable with difficulty and small conical lump smaller than the original glans approximately size ~1 cm diameter at the base attached horizontally at the left side of the original glans at the coronal sulcus and visible incomplete clefting in between the 2 glans visible from the aerial view. After approval from anesthetist, the patient was operated under general anesthesia by excision of pseudodiphallia. Urethral catheterization and circumcision of the penis after taking informed parental consent. Postoperatively, the period was uneventful. The patient responded well to the symptomatic treatment and was orally allowed on the same day evening. Urinary catheter was removed on 5th postoperative day. The patient was discharged on oral symptomatic medication and was advice for follow-up.