bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Procalcitonin as a Biomarker in Early Identification of Adverse Events Following Esophageal Atresia Surgery
Authors: Mahajan Dhruv , Goel Prabudh , Jain Vishesh , Dhua Anjan Kumar , Yadav Devendra Kumar , Verma Ajay , Sharma Ashok , Gupta Surabhi , Chaturvedi Pradeep Kumar , Kalaivani Mani , Agarwala Sandeep , Bajpai Minu 
Published: September 2023

ABSTRACT

Introduction:
Surgical complication following esophageal atresia repair is one of the several factors known to influence the final outcomes. Early identification of such complications may help in timely institution of therapeutic measures and translate into improved prognosis.

Objective:
The objective of this study was to evaluate the role of procalcitonin in early prediction of the adverse events after surgery in patients of esophageal atresia and the temporal relationship with clinical manifestations and other inflammatory biomarkers such as C-reactive protein (CRP).

Materials and Methods:
This was a prospective study on consecutive patients of esophageal atresia (n = 23). Serum procalcitonin and CRP levels were assessed at baseline (prior to surgery) and on postoperative days (POD) 1, 3, 5, 7, and 14. The trends in the biomarker values and temporal relationships of deviation in trend with the clinical and conventional laboratory parameters and patient outcomes were analyzed.

Results:
Baseline serum procalcitonin was elevated (n = 23; 1.7 ng/ml: min: 0.07 ng/ml–max: 24.36 ng/ml) in 18/23 (78.3%) patients. Procalcitonin nearly doubled on POD-1 (n = 22; 3.28 ng/ml: min: 0.64 ng/ml–max: 16.51 ng/ml) followed by a gradual decline. CRP was also elevated on POD-1 (three times the baseline) and depicted a delayed peak at POD-3. POD-1 procalcitonin and CRP levels correlated with survival. POD-1 procalcitonin cutoff at 3.28 ng/ml predicted mortality with a sensitivity and specificity of 100% and 57.9% (P = 0.05). Serum procalcitonin and CRP were higher for patients who sustained complications, so was the time required for hemodynamic stabilization. Procalcitonin (baseline and POD-5) and CRP (POD-3 and POD-5) values correlated with the clinical course after surgery. Baseline procalcitonin cutoff at 2.91 ng/ml predicted the possibility of a major complication with a sensitivity of 71.4% and a specificity of 93.3%. POD-5 procalcitonin cutoff at 1.38 ng/ml predicted the possibility of a major complication with a sensitivity of 83.3% and a specificity of 93.3%. Patients who sustained major complications depicted a change in serum procalcitonin trend 24–48 h ahead of clinical manifestation of an adverse event.

Conclusions:
Procalcitonin is a good indicator to identify the adverse events in neonates after surgery for esophageal atresia. The procalcitonin levels in patients who sustained a major complication depicted a reversal in trend 24–48 h of clinical manifestation. POD-1 procalcitonin correlated with survival while the baseline and POD-5 serum procalcitonin predicted the clinical course.
Fetal Klippel–Trenaunay–Weber Syndrome
Authors: Singh Neeta , Mandelia Ankur , Nigam Neha , Yadav Sangeeta , Pradhan Mandakini 
Published: September 2023

Context:
Klippel–Trenaunay–Weber syndrome (KTWS) is a rare disease characterized by a triad of venous malformations, vascular skin nevus and asymmetric hypertrophy of bone and soft tissue. The spectrum of disease in utero varies from asymptomatic nevus flammeus to life threatening complications like Kasabach–Merritt phenomena.

Aim:
The aim of this study was to review our experience of antenatal diagnosis of KTWS and it's postnatal management.

Settings and Design:
This was a retrospective observational study of all pregnant women who were antenatally diagnosed with KTWS and postnatally confirmed at a tertiary care center in north India between 2012 and 2021.

Subjects and Methods:
The electronic medical records were reviewed and data were collected regarding demographic information, obstetric history, clinical presentation, sonographic findings, mode of delivery, fetal outcome, and follow-up.

Results:
During the study period, four fetuses were diagnosed with KTWS on sonography. Three women were multigravida whereas one was a primigravida. Two women opted for medical termination of pregnancy and one each had liveborn child and an intra-uterine fetal death. KTWS was confirmed in all cases. The liveborn child underwent treatment for the vascular malformation and is alive at 4 years of age.

Conclusions:
This study attempts to add onto the available literature regarding the spectrum of prenatal presentations of KTWS. It emphasizes the importance of prenatal diagnosis and follow-up of the fetus/neonate.
Factors Affecting Parental Satisfaction after Male Circumcision
Authors: Wani Reyaz Ahmad , Mir Bilal Yousuf 
Published: September 2023

Background:
The safety of the male circumcision depends on many factors, including the surgeon, type of anesthesia, and associated complications. The scientific knowledge regarding safe MC is not so prevalent among masses.

Aims and Objectives:
To study the level of awareness regarding circumcision amongst parents and highlight factors linked to parental satisfaction.

Materials and Methods:
Information regarding various factors was gathered with the help of structured questionnaire-based evaluation of parental knowledge and experience. This was followed by clinical examination by a pediatric surgeon for assessment of cosmetic outcome, complications and need for additional surgical procedure.

Results:
Most circumcisions were performed by non-surgeons beyond neonatal period. Majority of the procedures were done under local anesthesia and around 17% procedures were done by quacks without anesthesia. More than 20% parents were dissatisfied with the procedure. Around 80% parents considered perioperative period mildly to moderately stressful. The overall complication rates were higher than usual with need for surgical correction in more than 40% patients.

Conclusion:
There is lack of awareness regarding safe MC practices in general public. MC by inexperienced people contributes to higher complication rates and need for redo, which in turn is related to parental dissatisfaction.
Reasons Behind Patients Defaulting from Elective Pediatric Urology Procedures at a Tertiary Private Teaching Hospital in South India
Authors: Manjarie Athiyaman Rani , Raj Shibi , Babu Ramesh 
Published: September 2023

Aim:
The aims of the study are to audit the default rate of the provisional date of elective surgery in pediatric urology private practice and to study the factors involved in the postponement of elective operation dates by patients.

Patients and Methods:
The audit involved analysis of reasons behind patients defaulting from elective pediatric urology procedures between January 2019 and December 2019 at a tertiary private teaching hospital in South India. The details were obtained from the outpatient register kept for elective booking. The details of actual procedures performed were obtained from OT records. From the defaulters, the reasons for postponement were obtained through personal/telephonic interview.

Results:
A total of 289 patients were given dates for elective procedures. Among this, 72 (24.9%) defaulted, leaving 217 patients who underwent elective surgery. Among those who underwent surgery, 90 (41%) were elective day case (DC) procedures, whereas 127 (59%) were inpatient (IP) procedures. The default rate was 26/116 (22.4%) for DC procedures, whereas 46/173 (26.6%) for IP procedures, with no significant difference between them (P = 0.64). Among the 72 defaulters, the reasons for cancellation were as follows: financial factors (FFs) 22 (30.6%), lack of family support 19 (26.4%), function/grievance in house 10 (13.9%), respiratory illness 14 (19.4%), and treatment at a different center 7 (9.7%). FF (insurance denial) was significantly higher (P = 0.001) in crucial IP procedures at 19/46 (41%) compared to DC procedures at 3/26 (12%). The various diagnoses denied insurance were UPJO (7), VUR (6), hypospadias (4), UDT (3), and PUV (2).

Conclusions:
FFs were mainly responsible for parents postponing their children's elective pediatric urology procedures in India. Universal insurance coverage for congenital anomalies might help overcome this most important cause of cancellations.
Peutz–Jeghers Syndrome
Authors: Shukla Ram Mohan , Tiwari Pooja , Dariya Samprati , Jain Sarvagya , Sharma Shashi Shankar , Laddha Ashok , Lahoti Brijesh Kumar , Thanna Hemant 
Published: September 2023

Introduction:
Peutz–Jeghers Syndrome (PJS) is an autosomal dominant disease presenting with hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on lips and oral mucosa. The incidence of this syndrome is approximately 1 in 1,20,000 births.

Materials and Methods:
In this article, we are presenting 11 cases of PJS which were misdiagnosed and patients were compelled to visit hospital repeatedly. All these cases were diagnosed based on clinical suspicion, family history, and histopathological examination of specimens. Most of the cases presented with intussusception and required emergency surgical management.

Results:
PJS can be diagnosed by the presence of microscopically confirmed hamartomatous polyps and a minimum of two of the following clinical criteria: Family history, mucocutaneous melanotic spots, and small bowel polyps with bleeding per rectally. The diagnosis can be missed if the melanotic spots on the face are missed. Routine investigations, imaging, and endoscopy were done in all cases. PJS patients need regular follow-up due to chance of recurrence of symptoms and susceptibility to cancer.

Conclusion:
PJS needs a high index of suspicion for diagnosis in cases of recurrent abdominal pain with bleeding per rectum. Proper family history and meticulous clinical examination for melanosis are very important to prevent the misdiagnosis of these cases.
Comparing Estimated and Measured Glomerular Filtration Rate in Children with Posterior Urethral Valve
Authors: Ora Manish , Kalimuthu Lokeshwaran Madurai , Mishra Prabhakar , Nazar Aftab Hasan , Bhadauria Dharmendra S. , Barai Sukanta , Gambhir Sanjay 
Published: September 2023

Background:
Posterior urethral valve (PUV) is obstructive uropathy that may lead to chronic kidney disease (CKD) and end-stage renal disease (ESRD) in children. Glomerular filtration rate (GFR) measurement remains the gold standard for renal function measurement. However, due to its less availability and cumbersome, it is not commonly used, and GFR is estimated utilizing various endogenous filtration markers.

Objective:
This study includes pediatric patients with PUV. We aimed to compare the measured GFR (mGFR) with various creatinine-based estimated GFR methods (eGFR).

Materials and Methods:
A single-center retrospective study included 62 treated cases of PUV, postvalve fulguration. The mGFR measured by 99mTc-diethylenetriaminepentaacetate in vitro method and compared with eight eGFR (Schwartz, Cockcroft-Gault [CG], Counahan-Barratt [CB], CKD Epidemiology Collaboration [CKD-EPI], full-age spectrum [FAS] age, FAS height (FAS Ht), Schwartz-Lyon [SL], and Ht independent). Patients were subdivided into different CKD grades and compared with various eGFR.

Discussion:
PUV is a common cause of CKD in children and needs special consideration as there is growth retardation associated with it. It decreases creatinine production and thus fallacies in eGFR measurement. There is a requisite to identify and closely monitor the subset of patients with baseline decreased renal function and therefore at risk of developing ESRD.

Results:
A total of 62 patients were included. Mean age and serum creatinine levels were 8.02 ± 5.53 years and 1.15 ± 0.95 mg/dl (range: 0.4–4.5), respectively. The mean mGFR was 61.6 ± 31.80 mL/min/1.73 m2 and a positive variable correlation was 0.46–0.77 between mGFR and eGFR. Based on mGFR, there were 14 (22.6%), 21 (33.8%), 13 (20.9%), 9 (14.5%), and 5 (8.1%) patients in Grades I–V, respectively. The correct classification of the CKD grades was noted in 25 (40.3%), 16 (25.8%), 32 (51.6%), 16 (25.8%), 25 (40.3%), 27 (43.5%), 26 (41.9%), and 28 (45.2%) patients by Schwartz, CG, CB, CKD-EPI, FAS age, FAS Ht, SL, and Ht-independent equation. The eGFR overestimates GFR at the lower level and underestimates at higher levels.

Conclusion:
Our results confirm the considerable limitations of various creatinine-based clearance methods for estimating actual GFR. The creatinine clearance-based eGFR should not replace the measurement of the GFR. An initial measure of the mGFR followed by serial follow-up with the eGFR equation may be done. The most accurate eGFR equations are CB for Grade II, SL or Ht independent for Grade III, FAS age for Grade IV, and SL for Grade V CKD.
Amyand's Hernia
Authors: Mathur Praveen , Mittal Priyanka , Kumar Ajay 
Published: September 2023

Purpose:
The presence of an appendix in the inguinal hernia sac is defined as Amyand's hernia (AH). This study intends to present the authors’ experience in dealing with this entity and also to present a discussion on possible need of updating its definition, classification, and management.

Materials and Methods:
A retrospective analysis of records of all pediatric patients undergoing surgery for congenital inguinal hernia in a single unit from January 2017 to March 2021 was done. Patient's demographics, clinical presentation, preoperative investigations, peroperative findings, and postoperative outcomes were recorded and analyzed.

Results:
AH was found in eight patients. All were boys. The median age of presentation was 20.5 months (range 2 months to 36 months). The mean duration of symptoms was 2 days (range 2 to 4 days). All patients presented with incarcerated inguinoscrotal swelling (right sided = 5, left sided = 3); associated with pain. An abdominal radiograph and ultrasonography were done for all. All patients underwent emergency surgery. Exploration was done for all through an inguinal incision. The appendix was found inflamed for two patients, and appendectomy was done for the same. None of the patients underwent incidental appendectomy. Wound infection, secondary appendicitis, and recurrence were not seen for any of the patients. The authors have also proposed a revised definition and classification of AH.

Conclusion:
AH is an interesting entity and many questions like the need for incidental appendectomy remain unanswered. An updating of the definition and classification system can probably offer some solution in this regard. However, more research is warranted in this regard.
Application of the Clamshell Thoracotomy in an Infant with a Large Mediastinal Tumor
Authors: Bendre Pradnya S. , Banerjee Arka , Munghate Gayatri , Karkera Parag Janardhan , Bodhanwala Minnie 
Published: September 2023

ABSTRACT
Historically it was recommended for emergency thoracotomy in thoracic trauma as the last resort when there was cardiopulmonary arrest. Nowadays, the only indications are lung transplantation and huge mediastinal masses. We report the use of a clamshell thoracotomy in a 7-month-old boy with a large anterior mediastinal mass extending into the bilateral thoracic cavities.
Study of placental histopathology in COVID-19 mothers at a dedicated COVID-19 hospital in India
Authors: Lad SK , Jashnani KD , Pophalkar M , Jnanananda B , Mahajan N 
Published: September 2023

ABSTRACT

Introduction:
Maternal infections can affect the placenta, which acts as a fetomaternal barrier. This study aimed to determine the spectrum of morphologic alterations in the placentas of pregnancies complicated by SARS-CoV-2 infection and the impact on fetal or neonatal outcomes.

Materials and Methods:
This is a prospective case-control study. One hundred SARS-CoV-2 positive pregnant women and an equal number of SARS CoV-2 negative pregnant women in their third trimester who delivered at our tertiary care center between December 2020 and November 2021 were enrolled in the study. This study was conducted at the end of the first wave and during the second COVID-19 wave. Histopathological examination of the placentas was done using Amsterdam consensus criteria. We observed for evidence of maternal vascular malperfusion [MVM], fetal vascular malperfusion, and inflammation in the placenta.

Results:
The clinical findings were compared between the cases and controls. Evidence of MVM was seen in comparable numbers between the cases and controls, but as it involved less than 30% of the placental disc, it was considered an insignificant finding. Deciduitis was seen in equal proportions in both groups. The comparison between the asymptomatic and symptomatic groups failed to show any difference in placental pathology between both groups. There was no adverse fetal outcome seen in the pregnancies complicated by SARS-CoV-2 infection.

Conclusion:
Placental injury at the microscopic level was observed but was neither significant nor specific to the SARS-CoV-2 infection. SARS CoV-2 infection did not influence the placental pathology. Also, no adverse neonatal outcomes were observed.
Using the Health Belief Model to Predict Pre-Travel Health Decisions among U.S.-Based Travelers
Authors: Rapheal Erica , Prithviraj Ranjini , Campbell Stephanie , Stoddard Steven T. , Paz-Soldan Valerie A. 
Published: September 2023

ABSTRACT.
International travelers are at increased risk of infectious disease, but almost half of Americans traveling to lower- and middle-income countries seek no health information before traveling. The Health Belief Model (HBM) can help evaluate decisions by categorizing behaviors into five categories: susceptibility, severity, benefits, barriers, and self-efficacy. This study sought to use the HBM to elucidate what may influence an individual to make certain pre-travel health decisions. We surveyed 604 participants who had recently traveled to an at-risk country. Participants were subset into nested groups: full population, sought any health information, and visited a clinic or health care provider (HCP). Survey questions were categorized according to the HBM, assembled into a priori models, and analyzed in each group using logistic regression with three main outcome variables: “Sought any pre-travel health information,” “Visited clinic or HCP,” and “Received vaccine.” Of the 604 participants, 333 (55%) sought any health information, 245 (41% of total) reported visiting an HCP, and 166 (27% of total) reported receiving a vaccine before traveling. Models containing variables from the susceptibility and benefits categories were most successful in predicting all three outcomes; susceptibility was a more relevant consideration in information seeking and seeing a provider than vaccination, whereas benefits was relevant for all outcomes. Our results emphasize the importance of an individual’s perceived susceptibility to disease and perceived benefit of interventions in predicting pre-travel health behaviors. Understanding this interaction can help shape how HCPs and public health entities can encourage health care seeking and vaccine uptake in travelers.
Una mirada hermenéutica desde el andar etnográfico hacia la gestión del conocimiento en la cibercomunidad de aprendizaje
Authors: Flores Ferrer Karla Migdalia , Montero Sopilca Any Sofia , Galindez Crespo Yimber Oscar , Campos Ocanto Alejandro José 
Published: September 2023

La virtualización de los escenarios cotidianos es una cuestión ineludible en especial para las universidades. Es por ello, que existe una necesidad impostergable de dirigir la mirada investigativa y acuciosa a este escenario relacional. El presente artpiculo científico se presenta en la modalidad de experiencia investigativa Su propósito fue generar reflexiones teóricas en torno al cómo se gestiona el conocimiento en una cibercomunidad de aprendizaje. Dicha experiencia fue llevada a cabo con 16 estudiantes de recién ingreso a la maestría Investigación Educacional de la UPEL-IPB. Se desarrolló desde una experiencia etnográfica haciendo una hermenéusis a cada acción y aporte académico de los participantes en el escenario virtual de aprendizaje. El principal aporte de este estudio es la presencia del espiral de aprendizaje y la evolución del aprendizaje tácito a explícito.
Diagnóstico FODA como elemento de planeación estratégica de negocios de producción de cacao CCN51 en el Triunfo, Guayas, Ecuador
Authors: Cali Cadena Karina Marisela , Delgado Delgado Dilmar Danilo , Delgado Delgado Dilmar Danilo , Pilaloa David Wilmer Omar , Holguin Burgos Bertha Patricia , Holguin Burgos Bertha Patricia 
Published: September 2023

Este trabajo proporciona información básica sobre la planificación estratégica y una de sus herramientas básicas: el análisis FODA que permite la recopilación y utilización de datos obteniendo un perfil operativo de una empresa. Dicho análisis, aplica para cualquier empresa tamaño o tipo. Las decisiones administrativas tienen procedimientos crear un diagnóstico, esto hace que sea fácil obtener decisiones y desarrollo de estrategias. Para comprender mejor estos procesos, se definen algunos de sus elementos básicos. También se proporcionan los pasos para hacerlo. Los aspectos metodológicos de esta investigación incluyen enfoques cualitativos y cuantitativos, deductivos, analíticos y sintéticos. La técnica empleada que son las encuestas dirigidas a los productores de cacao CCN51 en El Triunfo permite el análisis e interpretación de la recolección de la información, las personas brindan información real para comprender el estado actual del entorno tanto dentro como fuera de la empresa. De manera similar, se deben investigar las tendencias y los cambios que ocurren en el medio ambiente. Como resultado se puede concluir que existe una falta de comprensión del concepto e importancia de la planificación estratégica de la empresa para poder plantear un plan estratégico de la misma
Religiosity and Local Wisdom: Economic Security Strategy of Women of Indigenous Community
Authors: Oppier Hermi , Tuasuun Selvenco , Hahury Hendri Dony , Saptenno Febryano , Louhenapessy Fredy Hendry 
Published: September 2023

This article highlights the meaning of ecclesiastical teachings based on the Bible as the Word of God in an effort to meet the needs of the poor in the Negeri (village) Booi congregation through the tradition or local wisdom of “nutmeg collecting”. This study employs Max Weber’s point of view on social action, where for every social activity carried out, there is always an internal motivation (Vertehen). This study was done in a qualitative manner with an ethnographic approach conducted in April 2022 – December 2022. The data was collected through in-depth interviews, observation and documentation. The data was analyzed following the stages proposed by Chariri with source triangulation as a strategy in examining the data validity. The results show that the local wisdom of “nutmeg collecting” could be used as a strategy in overcoming poverty problems, especially related to income inequality experienced by women. In the mainstream (classical/neoclassical) economic views, the behavior of this indigenous community was certainly very detrimental, as it was related to efforts to maximize income for oneself. However, on the contrary, this local wisdom also emphasized the needs of others which were supported by the religious teachings they believed in. This condition also emphasized that the presence of the local wisdom supported by the religious teachings was an informal insurance that the needs of the poor women of the indigenous community would always be met at any time through the availability of fallen nutmeg.