Body Image Issues Among Late Adolescent Boys

Background: Adolescence is the age where individuals undergo a lot of changes. Among the physiological, psychological, social changes, adolescents usually worry about the physical changes that takes place. The rapid changes in the body creates certain confidence in few; and uncertainty and self-doubt in few of the individuals. They are also in the process of creating an identity for themselves and understanding their changing bodies. The present study aimed to investigate the changes in the level of Body Image Issues among Adolescent Boys. Methodology: A purposive sampling of 30 adolescents across Karnataka state, were considered for the study. Body Image questionnaire tool was used. Kruskal Wallis test adopted for statistical analysis; done using SPSS version 22. Results: The mean scores for ages 16-, 17- and 18- years are 43.20, 62.90 and 56.70 respectively. And their corresponding standard deviations are 16.578, 31.328 and 23.262 respectively. The p value obtained is .203. Which indicates that there is no significant difference in the level of Body Image among late adolescent boys. Conclusion: The results indicate that the level of Body image is not significant among late adolescent boys

A Case of Neonatal Severe Hyperparathyroidism: Challenges in Management

Neonatal severe hyperparathyroidism is a rare disorder arising from inherited defects in the calcium sensing receptor (CaSR) that presents early in life with severe hypercalcemia, failure to thrive, and developmental retardation. The authors describe an infant with neonatal severe hyperparathyroidism due to homozygous CaSR gene mutation presenting with recurrent episodes of severe hypercalcemia, growth retardation, and developmental delay. Medical management served as an efective bridge therapy to surgery. Total parathyroidectomy with right hemithyroidectomy was performed at 7 mo of age and resulted in successful cure and normalization of growth and developmental milestones. Timely medical and surgical management can help prevent mortality and morbidity in the form of neurodevelopmental sequelae. Life-long monitoring and treatment is mandatory for the resultant hypoparathyroidism.

A comprehensive yoga programme for weight reduction in children & adolescents with obesity: A randomized controlled trial

Background & objectives: Obesity is a rising pandemic in childhood. There is scarcity of evidence on the efficacy of yoga in achieving weight loss in overweight/obese children. The objective of this study was to assess the efficacy of family-based comprehensive yoga intervention in the reduction of body mass index (BMI) in overweight/obese children, in comparison to standard dietary and lifestyle counselling and control group. Methods: This was an open-label randomized controlled study. Children aged 8-15 yr who were overweight or had obesity were randomized to one of the three arms for 18 wk; standard weight management (group 1), yoga with dietary modification (group 2) and control (no intervention; group 3). Reduction in BMI and improvement in physiological, biochemical and psychological parameters from baseline to 18 wk was compared between the three arms. Late follow up was also done at 6-12 months. Results: A total of 165 children with mean±standard deviation (SD) age of 11.6±1.8 yr and mean BMI 26.3±4.2 kg/m2 were enrolled. Outcome analysis at 18 wk was performed for 109 children. Improved diet quality and reduced intake were observed in both intervention arms. The median (IQR) reduction in BMI in standard and yoga arms was similar [?1.4 (?3.1, ?0.5) kg/m2 and ?1.2 (?2.3, ?0.6) kg/m2, respectively], while it increased by +0.3 (?0.3, 0.1) in the control arm. In the yoga arm, mean systolic BP reduced from 118 (10) to 114 (8) mmHg, (P=0.019). In the standard arm, significant improvement in psychological scores was noted. In group 3, the mean fasting glucose increased from 93±10 to 102±12 mg/dl (P<0.001). Interpretation & conclusions: The findings of the present study suggest that yoga in conjunction with dietary modification is equally effective as the standard weight management for BMI reduction in the paediatric age group.

Marathi translation, linguistic validation, and cross?cultural adaptation of speech handicap index and voice handicap index in patients of head and neck squamous cell cancer

Background: Patient reported treatment outcomes is a better way to measure the quality of life (QOL). This study was undertaken to translate the speech handicap index (SHI) and voice handicap index (VHI) in Marathi language and its linguistic validation and cross-cultural adaptation in patients of head and neck squamous cell cancer (HNSCC). Methods: SHI and VHI were translated into Marathi with prior permission from the respective authors of original English questionnaire (RAs). The translation procedure for each tool included two forward translations (English to Marathi), the formation of first intermediate Marathi translation (FIT), two back translations (Marathi to English) of FIT, and interim Marathi translation (IT) formation. The second intermediate Marathi translation (SIT) was prepared after face validation of IT by a subject expert. Pretesting of SIT was done in 20 patients of HNSCC to validate linguistic and cross-cultural adaptation. By incorporating the patient’s suggestions, the final Marathi translation was prepared and sent to primary authors for approval. Results: The grammatically and conceptually acceptable and face validated SIT was prepared and administered to HNSCC patients. The patients of the oral cavity and larynx were in SHI and VHI group, respectively (ten patients in each group). The questionnaire was well understood reflecting its linguistic and cross-cultural adaptation. Some of the patients suggested changes in a few words which were then corrected, rechecked with back translation, and final Marathi translated questionnaire was prepared. It was approved by RAs. Conclusion: Marathi translation of SHI and VHI are well accepted and comprehensible. It can be used for future studies.

Molecular Characterization and Management of Congenital Hyperinsulinism: A Tertiary Centre Experience

Background: There is limited data from India regarding medical management of congenital hyperinsulinism (CHI). Objective: To study the molecular diagnosis, medical management and outcomes of children with CHI. Study design: Ambispective. Participants: Children with CHI admitted in from December, 2011 till March, 2020 at a tertiary care referral hospital. Outcomes: Clinical and genetic profile, treatment, and response Results: 42 children with a median age of 3 days (range 1 day to 6 years) were enrolled, of which 23 (54.7%) were diazoxideresponsive. Mutations were identified in 28 out of 41 (68.2%) patients. The commonest gene affected was ABCC8 in 22 patients. The pathogenic variant c.331G>A in ABCC8 gene was identified in 6 unrelated cases from one community. Good response to daily octreotide was seen in 13 of the 19 (68.4%) diazoxide-unresponsive patients. Monthly long-acting octreotide was initiated and daily octreotide could be stopped or tapered in 9 patients. Sirolimus was tried with variable response in 6 patients but was discontinued in 5 due to adverse effects. Four patients had focal CHI, of which one underwent partial pancreatic resection. The disease severity reduced with age and neurodevelopment was good in the patients with identifiable genetic defects who were optimally managed. Conclusions: Medical management of CHI is effective, if compliance can be ensured, with good quality of life and neurological outcomes.

Management of Infants with Congenital Adrenal Hyperplasia

Treatment of congenital adrenal hyperplasia (CAH) requires lifelong replacement of glucocorticoids with regular follow up to manageassociated morbidities. The current review focuses on follow-up and management of infants diagnosed with classical CAH pertinent toIndian context. Early initiation of oral hydrocortisone in divided doses is recommended after diagnosis in newborn period, infancy andchildhood. Fludrocortisone is recommended for all infants with classical CAH. All infants should be monitored as per protocol fordisease and treatment related complications. The role of prenatal steroids to pregnant women with previous history of CAH affectedinfant for prevention of virilization of female fetus is controversial.

Newborn Screening and Diagnosis of Infants with Congenital Adrenal Hyperplasia

Congenital adrenal hyperplasia (CAH) is an autosomal recessive endocrine disorder which can manifest after birth with ambiguousgenitalia and salt-wasting crisis. However, genital ambiguity is not seen in male babies and may be mild in female babies, leading to amissed diagnosis of classical CAH at birth. In this review, we provide a standard operating protocol for routine newborn screening forCAH in Indian settings. A standardization of first tier screening tests with a single consistent set of cut-off values stratified by gestationalage is also suggested. The protocol also recommends a two-tier protocol of initial immunoassay/time resolved fluoroimmunoassayfollowed by liquid chromatography tandem mass spectrometry for confirmation of screen positive babies, wherever feasible. Routinemolecular and genetic testing is not essential for establishing the diagnosis in all screen positive babies, but has significant utility inprenatal diagnosis and genetic counseling for future pregnancy.

An Optimal Capillary Screen Cut-off of Thyroid Stimulating Hormone for Diagnosing Congenital Hypothyroidism: Data from a Pilot Newborn Screening Program in Delhi

Objective: To determine an appropriate cut-off of capillaryThyroid stimulating hormone (TSH) for congenitalhypothyroidism.Study design: Cross-sectional.Participants: 174,000 neonates born in different hospitals ofDelhi, India, from November 2014 to October 2016.Main outcome measures: Correlation between initial andrepeat capillary TSH level and subsequent venous free thyroxine(fT4) level.Results: 102 newborns with initial/ repeat capillary TSH level of≥20 mIU/L (n=174) were confirmed to have congenitalhypothyroidism at mean (SD) age of 5 (4) days. A goodcorrelation between capillary TSH level and confirmatory venousfT4 level and postnatal age of sampling was obtained (r -0.6,-0.4). The area under the ROC curve (AUC) was 0.81 (95%CI0.75 to 0.88), indicating referral capillary TSH level of 20 mIU/L tobe a good predictor of subsequent high venous TSH level.Conclusion: A cut off of ≥20 mIU/L for capillary TSH screeningbeyond 24 hours of life is optimal in the Indian setting for decidingfurther recall and workup, keeping a balance between sensitivityand recall rate.

Various addiction patterns, dietary habits, associated medical problems, and socioeconomic status in gastrointestinal malignancies: A prospective study in rural area of Maharashtra, India

Background: Gastrointestinal (GI) malignancies are increasing with advancing age. Various addictions and poor dietary habits are among the major risk factors. Early detection is difficult until patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in early diagnosis and better treatment outcome. Objectives: This study is carried out to see various addiction patterns, dietary habits, associated medical problems, and socioeconomic status with various sites involved in GI malignancies, at a tertiary care teaching hospital of Western Maharashtra, India. Materials and Methods: Prospective questionnaire-based study was carried out for 11 months. A total of 100 diagnosed carcinoma cases of GI tract malignancy were taken for study. Results and Conclusions: Out of total 100 cases, 61 were male and 39 were female. The most common site involved was esophagus (41) followed by rectosigmoid, colon and cecum, stomach, and anal canal (29, 14, 13, and 3, respectively). There were 45% of cases above 60 years of age. The most common addiction was smokeless tobacco. Most of the patients belonged to lower and upper lower class (64%). Majority of cases (81%) were nonvegetarian, only 16% were pure vegetarian. Most of the cases (85%) were in advanced stage of disease (III and IV). Awareness program for harmful effects of various addictions and importance of high-fiber diet (vegetarian diet) will help in health promotion and prevention of various malignancies. Awareness about the early symptoms of GI malignancy will help in early detection of disease and better treatment outcome.

Distal Renal Tubular Acidosis Associated with Celiac Disease and Thyroiditis.

Background: Association of distal renal tubular acidosis (RTA) with autoimmune diseases is extremely rare in children.Case Characteristics: 12-year-old girl with distal RTA. Despite resolution of acidosis on bicarbonate, she continued to have poor growth and delayed puberty. Investigations revealed autoimmune thyroiditis and celiac disease. Outcome: Levothyroxine and gluten-free diet were initiated. Child gained height and weight and had onset of puberty after gluten withdrawal. Messages: Distal RTA in children may rarely be of autoimmune etiology.

Hyperinsulinemic Hypoglycemia of Infancy due to Novel HADH Mutation in Two Siblings.

Background: Hyperinsulinemia is the commonest cause of persistent hypoglycemia in infancy. Inactivating mutations in the genes ABCC8 and KCNJ11 are the commonest cause. Mutation in the HADH gene, which encodes the short-chain-L-3-hydroxyacyl-CoA dehydrogenase, is a rare cause. Case characteristics: Two Indian sisters who presented with hyperinsulinemic hypoglycemia of infancy. Observation/Intervention: A novel homozygous missense mutation in the HADH gene was identified in both the sisters, while the parents were found to be heterozygous carriers. Outcome: Establishment of molecular diagnosis, optimization of therapy and counseling of parents regarding risk of recurrence in future pregnancy. Messages: HADH mutations are rare causes of hypoglycemia and can be mitigated with diazoxide and appropriate dietary therapy if identified early.

Solid variant of orbital angioleiomyoma: An unusual tumor at an unusual site.

We describe the clinicopathological features of a solid variant of orbital angioleiomyoma. A review of clinical records, diagnostic, and radiographic studies combined with histopathological evaluation with standard histochemical staining and immunohistochemistry was conducted. A 22‑year‑old male patient presented with a mass in the region of the left lacrimal gland that was gradually increasing over the past 2 years. Radiological and clinical examinations showed no signs suspicious of a malignancy and fine needle aspiration cytology was inconclusive. Therefore, an excision biopsy was performed. On histopathological examination, the picture was consistent with a benign spindle cell tumor. Immunohistochemistry showed positivity for CD 34 and CD 31 (markers for vascular endothelium). The tumor also showed positivity for smooth muscle actin and Ki‑67 proliferative index was low. Angioleiomyomas are rarely encountered in the orbit and has features seen in leiomyoma as well as some vascular tumor elements. In most cases, surgical excision is usually curative.

Surgeon point‑of‑view recording: Using a high‑definition head‑mounted video camera in the operating room.

Objective: To study the utility of a commercially available small, portable ultra‑high definition (HD) camera (GoPro Hero 4) for intraoperative recording. Methods: A head mount was used to fix the camera on the operating surgeon’s head. Due care was taken to protect the patient’s identity. The recorded video was subsequently edited and used as a teaching tool. This retrospective, noncomparative study was conducted at three tertiary eye care centers. The surgeries recorded were ptosis correction, ectropion correction, dacryocystorhinostomy, angular dermoid excision, enucleation, blepharoplasty and lid tear repair surgery (one each). The recorded videos were reviewed, edited, and checked for clarity, resolution, and reproducibility. Results: The recorded videos were found to be high quality, which allowed for zooming and visualization of the surgical anatomy clearly. Minimal distortion is a drawback that can be effectively addressed during postproduction. The camera, owing to its lightweight and small size, can be mounted on the surgeon’s head, thus offering a unique surgeon point‑of‑view. In our experience, the results were of good quality and reproducible. Conclusions: A head‑mounted ultra‑HD video recording system is a cheap, high quality, and unobtrusive technique to record surgery and can be a useful teaching tool in external facial and ophthalmic plastic surgery.

Surreptitious Insulin Overdosing in Adolescents with Type 1 Diabetes.

Background: Hypoglycemia in children and adolescents with type 1 diabetes has diverse etiologies. Case Characteristics: We report recurrent hypoglycemia in three children with type 1 diabetes because of insulin overdose. Intervention: Hospitalization and counseling by treating team and psychologist helped in resolving the recurrent hypoglycemia. Outcome: Improvement in glycemic control was achieved. Message: Adolescents with type 1 diabetes may take extra insulin to consume more carbohydrates, or to seek attention. Parents should share the responsibility of care of adolescents during transition phase for better glycemic control.

Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation.

Surgical emphysema is defined as gas or air trapped in the subcutaneous tissue plane. Here, we report a rare case of bilateral periorbital and cervicofacial subcutaneous emphysema following a vitreoretinal surgery for inadvertent globe perforation during the administration of peribulbar anesthesia. This condition, although self‑resolving when restricted to the subcutaneous plane has the potential to spread into deeper tissue planes such as the retropharyngeal space. The presence of crepitus helps to distinguish it from angioneurotic edema. Ophthalmologists must be sensitive to the fact that surgical emphysema can be a very rare, but possible complication of an intraocular surgery following globe perforation.

The Study of Teeth eruption in Female Children of Malwa Region – A Correlation with age.

Background: Tooth eruption is a physiological process in which the tooth migrates from the maxillary bone towards the oral cavity, at the end of which teeth find their place on the arch creating vicinity relations according to a genetic code characteristic to each individual. Dental eruption begins with the eruption of the first primary teeth around 6 months and finishes at 2 years and a half for primary teeth, and around 18-25 years for permanent teeth, when the third molar erupts. Aim: The teeth’s eruption and devlopment is, usually, related to the child’s chronological age, but there can also be some variations. The aim of this study was to analyze the pattern of eruption of teeth, to define any variation in eruption of deciduous and permanent teeth. Material and methods: 500 female children from pre primary and primary Government school, and Dental outpatient department within the age group of 0-12 years were randomly examined and range of time of eruption of teeth was calculated for central and lateral incisors, canines, premolars,1st and 2nd molars, in both maxilla and mandible. Results: It was found that in case of deciduous teeth, in the study population, lateral incisors, canines and first molars erupted earlier in the upper jaw and the central incisors, and second molars erupted earlier in the lower jaw. In the case of permanent teeth all the teeth i.e. central incisors, lateral incisors, canines, first pre molars and second pre molars erupted earlier in lower jaw. Only the first and second molars erupted earlier in the upper jaw. Conclusion: Tooth eruption time and sequence are important factors in dental treatment planning, particularly in orthodontics, but also in forensic dentistry to estimate age of a child. It was concluded that the eruption of teeth was earlier in mandible (lower jaw) than in maxilla (upper jaw) in the case of permanent teeth.

Correlation of volume of both the kidneys in both the sexes among different age groups of normal North Indian population – An ultrasonographic study.

Background: Dimensions of kidney form an extremly important parameter for diagnosis and prognosis of renal pathologies. Dimensions vary according to the geographical locations, racial variations, diet, environment and frequency of pathologies. Renal sizes in Indian population although studied frequently have not been standardized. Aim: The study was aimed at establishing Aim: The study was aimed at establishing some preliminary data of normal North Indian population, without a known renal pathology. Material and methods: Renal measurements i.e., length, width and parenchymal thickness were measured in 164 individuals, both males and females and their renal volume was calculated. The volume was then correlated with the age of the individuals. Analysis was then done for variability due to age, gender and laterality. Results: It was found that the males showed the maximum volume for both the right and the left kidneys in the fourth decade, where as the females had a maximum volume in the third decade. Volume tended to decrease after the fourth decade. The volume of the left kidney was more as compared to that of right side for both the males and females. Conclusion: Renal sizes of Indian are invariably lesser as compared to commonly quoted normal values in standard literatures. Inferences about renal sizes need to be made with reference to racial and regional variations rather than basing them on data from other population.

Crown-Rump Length estimation of Human Fetuses by external surface area of Right Parietal bone.

Background: Despite enormous volume of research devoted to the skeletogenous and to the quantitative studies of the developing and mature skeleton, the growth of skull in respect to its surface area is still never been comprehensively studied. Since classical study of Streeter reported gestational age estimation from crown-rump length (CRL), numerous investigators have studied and reported various measures of fetal growth during pregnancy such as biparietal diameter, diaphyseal length of long bones and even cephalometric growth analysis. Present study was done in dried fetal skull bones by calculation of their external surface area and estimation of linear correlation with crown-rump length and hence determination of gestational age. Aim: To establish the correlation between the external surface area of right parietal bone and crown-rump length, to predict fetal age from crown-rump length and circulation of growth rate of right parietal bone. Material and methods: Fifty apparently normal fetuses ranging from 12 cm -42 cm CR length of both sexes were obtained from the Departmen of Obstetrics and Gynecology, of our native hospital. After measuring crown-rump length of each fetal skull after removing brain tissue via foramen magnum was then kept for maceration in running tap water. After complete maceration and separation of right parietal skull bone, measurement of external surface area of right parietal skull bone was obtained using wet cotton cloth, marker pen and graph paper. Results: The regression values were plotted in the graph and these values were found to cluster around the standard straight line and are in hand with the straight line indicating highly significant results. Conclusion: In the present study, CR length was estimated from external surface area of right parietal bone. A definite correlation was observed between external surface area of right parietal bone and CR length.