Preoperative topical estrogen application in the management of hypospadias: a systematic review.

Local estrogen therapy has been explored as an alternative to conventional testosterone therapy in children requiring urethroplasty for hypospadias. Our objective is to evaluate if preoperative estrogen stimulation reduces post-urethroplasty complications and enhances penile dimensions. A systematic search was conducted on various databases, selecting only randomized controlled trials (RCTs) that tested estrogen on hypospadias patients under 18 years. Articles underwent sorting following PRISMA guidelines and bias risk was assessed using the JBI clinical appraisal tool for RCTs. Out of 607 screened records, 10 underwent full-text review, and 4 randomized controlled trials (RCTs) were selected for analysis. The total patient cohort across studies was 387 with 174 in the estrogen group. All studies utilized topical estrogen, but in different formulations and timings. Prudence is necessary for interpreting results due to variations in formulation, timing, and hypospadias type across studies. Limited by a small number of studies and outcome presentation non-uniformity, the review suggests no change in penile dimensions or postoperative complications with topical estrogen. Further research is needed to explore wound-healing properties of estrogen in hypospadias through animal and human studies.Registration and protocol: Registered in Prospero CRD42024502183.

Xanthogranulomatous Pyelonephritis in a Neonate Masquerading as Renal Mass.

Xanthogranulomatous pyelonephritis (XGP), a variant of chronic obstructive pyelonephritis, is a very rare diagnosis in neonates with three reported cases to date. It is often misdiagnosed in infancy as it mimics the features of renal mass. Herein, we report a case of 20-day-old neonate with XGP presenting as a renal mass.

Ultrasound-guided procedures for postoperative pain management in pediatric patients undergoing abdominal surgeries: A systematic review.

Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.

A Case Report on Hendren's Technique for Managing Symptomatic Isolated Urogenital Sinus in an Infant.

Isolated urogenital sinus is a rare anomaly. These cases may have high confluence which adds complexity to surgical correction. There are controversies regarding timing and techniques of management. We present a case report on managing such a case in an infant with bladder outlet obstruction and pyocolpos.

P-N heterojunction NiO/ZnO nanowire based electrode for asymmetric supercapacitor applications.

Nickel-based oxides are selected for their inexpensive cost, well-defined redox activity, and flexibility in adjusting nanostructures via optimization of the synthesis process. This communique explores the field of energy storage for hydrothermally synthesized NiO/ZnO nanowires by analysing their capacitive behaviour. The p-type NiO was successfully built onto the well-ordered mesoporous n-type ZnO matrix, resulting in the formation of p-n heterojunction artefacts with porous nanowire architectures. NiO/ZnO nanowire-based electrodes exhibited much higher electrochemical characteristics than bare NiO nanowires. The heterojunction at the interface between the NiO and ZnO nanoparticles, their specific surface area, as well as their combined synergetic influence, are accountable for the high specific capacitance (Cs) of 1135 Fg-1at a scan rate of 5 mV s-1. NiO/ZnO nanowires show an 18% dip in initial capacitance even after 6000 cycles, indicating excellent capacitance retention and low resistance validated by electrochemical impedance spectroscopy. In addition, the specific capacitance, energy and power density of the solid state asymmetric capacitor that was manufactured by employing NiO/ZnO as the positive electrode and activated carbon as the negative electrode were found to be 87 Fg-1, 23 Whkg-1and 614 Wkg-1, respectively. The novel electrode based on NiO/ZnO demonstrates excellent electrochemical characteristics all of which point to its promising application in supercapacitor devices.

Simultaneous Detection of Influenza A/B, Respiratory Syncytial Virus, and SARS-CoV-2 in Nasopharyngeal Swabs by One-Tube Multiplex Reverse Transcription Polymerase Chain Reaction.

The treatment and outcome of respiratory virus infections differ. SARS-CoV-2, as well as other respiratory viruses such as influenza virus (A and B) and respiratory syncytial virus (RSV), require simultaneous, cost-effective, and rapid differential detection. We used a gold standard five-target single-step RT-PCR to detect influenza viruses, RSV, and SARS-CoV-2, and this method can be extended to detect influenza virus subtypes. As a result, this five-target single-step RT-PCR method is ideal for differentiating respiratory viruses. The 5' nuclease activity of Taq DNA polymerase is used in the real-time reverse transcription PCR assay. The Taq man fast viral 1-step enzyme is a 4× Master mix and five-target primer probe mix that detects influenza A, influenza B, SARS-CoV-2 ORF1ab, respiratory syncytial viruses A/B and actin. When compared with TaqMan TM and Invitrogen superscript TM III Platinum and the Meril Kit for SARS-CoV-2, the assay demonstrated 100% sensitivity, specificity, and amplification efficiency of 90.1% for target genes. In conclusion, our one-tube multiplex RT-PCR assay offers a rapid and reliable method for the simultaneous detection of influenza A/B, RSV, and SARS-CoV-2 from nasopharyngeal swabs. This assay has the potential to enhance diagnostic capabilities and improve public health responses during respiratory outbreaks, enabling timely interventions and informed decision making.

An Unusual Case of Hereditary Neuropathy With Liability to Pressure Palsy: A Diagnostic Challenge.

Hereditary neuropathy with liability to pressure palsy (HNPP) is a genetic condition in which individuals develop recurrent nerve palsies due to nerve injury at susceptible anatomic sites. Because of its rarity, other diseases usually appear high in the differential list when the clinical presentation is suggestive. Here, we describe a case of HNPP initially thought of as radiculopathy and focal chronic inflammatory demyelinating polyneuropathy (CIDP). Only on close clinical examination, supportive electrodiagnostic tests, and recurrence with typical history, a diagnosis of HNPP was suspected and later confirmed by a genetic test.

Unilateral Choroidal Granuloma and a Pupillary Abnormality in a Case of Miliary Tuberculosis: A Dilemma for the Physician.

A young woman presented to the emergency with acute paraplegia and vision loss. She was diagnosed two months ago as a case of miliary tuberculosis with involvement of the chest and brain and therefore was on anti-tuberculosis treatment (ATT). She developed a decrease in vision and her treating physician suspecting optic neuropathy altered the regimen so as to omit Ethambutol and replaced it with Streptomycin. This treatment could not be continued with the advent of the COVID-19 pandemic as it required a hospital visit. On admission, she gave a history of inconsistent treatment and the ophthalmology evaluation showed decreased vision in the left eye, a relative afferent pupillary defect (RAPD), and a large solitary choroidal tubercle at the posterior pole of the same eye. The right eye was normal. On discussion with the treating physician, the standard four-drug ATT was reinstituted. Through our case report, we wish to highlight a challenging situation wherein the vision loss and pupillary abnormality with a background of ATT led to the change of treatment that would have required either daily hospital visits or other arrangements to be made to provide the same at home. This modified regimen not only proved to be challenging for the patient and caregivers but also may have played a role in the newer onset of further complications secondary to an irregular treatment regime.

The Characteristics and Patterns of Drug-Resistant Pulmonary Tuberculosis in Eastern India.

BACKGROUND: Drug-resistant tuberculosis is a major public health problem throughout the world and accounts for substantial morbidity and mortality rates in India, too. Early diagnosis is the corner stone of tuberculosis treatment. State-level and cluster-wise variations in drug resistance is a possibility and should be regularly checked in from time to time. MATERIALS AND METHODS: The present prospective cohort study (January 2019 to May 2022) was conducted in Darbhanga Medical College and Hospital on drug-resistant pulmonary tuberculosis patients. Sputum specimens were collected from designated centers. Rapid molecular drug-resistance testing (genotypic tests) and growth-based drug-susceptibility testing (DST) (phenotypic tests) were performed in the National Tuberculosis Elimination Program certified Laboratory. RESULTS: A total of 268 patients with drug-resistant pulmonary tuberculosis were included in the study group. The treatment outcomes revealed as cured in 100 (37.31%); treatment completed in 43 (16.04%); died in 56 (20.89%); treatment failed in 22 (8.21%); loss of follow up in 34 (12.69%); and transferred out in 13 (4.85%) drug-resistant pulmonary tuberculosis patients. Adverse events were recorded in 199 (74.25%) of the drug-resistant pulmonary tuberculosis patients. CONCLUSIONS: Drug-resistant pulmonary tuberculosis patients are a matter of concern and need to be addressed.

Delayed complication due to retained contrast following augmented pressure distal loop colostogram in anorectal malformation.

Augmented-pressure distal loop colostogram (APDC) is the most important diagnostic investigation to delineate the detailed anatomy to plan the reparative management of anorectal malformations. APDC is generally considered safe, with a very low complication rate. Herein, we present an unreported complication of APDC, manifesting as acute abdomen, due to retained contrast in distal loop. The patient was managed with evacuation of retained contrast from distal loop. We recommend evacuating the contrast from the distal loop following APDC.

Bronchiectasis without lower respiratory symptoms in the presence of multisystem anomalies - a clinical clue to diagnose esophageal lung anomaly.

Esophageal lung is a type of Group-II communicating bronchopulmonary foregut malformations (CBPFM) usually diagnosed beyond neonatal period during investigation for recurrent respiratory symptoms and persistent radiographic features suggesting pneumonia or bronchiectasis. In our case, we noticed bronchiectasis and disproportionately severe volume loss in an infant with associated multisystem anomalies in the absence of "significant" lower respiratory tract symptoms. A detailed evaluation with repeat imaging confirmed a Group-II CBPFM, a congenital pathology instead of an infective cause. Pneumonectomy is a more prudent option instead of undertaking major airway reconstruction for the dysplastic "dysfunctional" tissue. Amongst the various associated anomalies reported till now, the associated rib and renal anomalies noted by us have not been described earlier to the best of our knowledge.

Opsoclonus-Myoclonus in a Patient With Japanese Encephalitis: A Video-Based Case.

Japanese encephalitis is one of the most important causes of viral encephalitis in Asian countries caused by an arbovirus belonging to the flavivirus family. Complications following infection are frequent. Most common complications include dystonia, movement disorders, seizures, behavioral abnormalities, and persistent cognitive impairment. Herein, we describe a patient who after one month of being diagnosed with Japanese encephalitis developed opsoclonus-myoclonus. At a two-month follow-up, opsoclonus-myoclonus significantly improved with steroid therapy.

Two Cases of Tonic Pupil: Ross and Ross Syndrome Plus.

Ross syndrome is a rare disorder of the peripheral autonomic nervous system characterized by a triad of tonic pupils with light-near dissociation, segmental anhidrosis, and areflexia. Though having a benign course, the disease can cause significant social embarrassment. Both our cases presented with complaints of segmental facial hyperhidrosis. The first case with a one-year history had findings of segmental anhidrosis up to T4 thoracic level, left tonic pupil, and absent right ankle reflex. While the second case with a history of five years had bilateral tonic pupil, absent lower limb reflexes, anhidrosis of left face, neck, and upper trunk up to T4 level, apart from having associated Horner's syndrome. Minor's (starch-iodine) test and dilute pilocarpine test were helpful for diagnosis in both cases, indicating areas of anhidrosis and pupillary cholinergic denervation hypersensitivity respectively. Both cases were provided counseling and managed conservatively.

Challenges in the management of paediatric surgical patients in the midst of COVID-19 crisis: Our experience.

INTRODUCTION: As a result of the coronavirus disease (COVID-19) pandemic, more than 28 million planned surgeries worldwide could be cancelled leading to patients facing long waiting period for their treatment. The outbreak of COVID-19 caused by severe acute respiratory syndrome coronavirus (SARS CoV-2) has spread to more than 220 countries around the world and has almost stopped all routine surgical work. In children, the delay in the management of surgical diseases could result in significant morbidity and mortality. MATERIAL AND METHOD: Herein, we describe our experience with the management of Paediatric Surgical patients at our centre which is a tertiary level hospital catering to both COVID-19 positive and Non-COVID patients in all specialties. OBSERVATION AND RESULTS: During the COVID-19 pandemic, 69.41% fewer paediatric surgical patients underwent surgery relative to the corresponding period 1 year earlier. However, the number of emergency cases performed increased during the COVID pandemic by 62.12%, mostly involving, urological and gastrointestinal emergencies. CONCLUSION: As we gain experience in effective protocol-based management, which can be revised based on the evolving scientific evidence. It will be appropriate to resume the elective work in selected patients, following the appropriate level of precautions.

A Case of Bilateral Central Retinal Artery Occlusion in a Post-COVID Rhino-Orbital-Cerebral Mucormycosis Patient.

Central retinal artery occlusion (CRAO) is a multifactorial disease, where inflammation and hypercoagulability are the major risk factors. It is a rare occurrence in this geographical area in patients diagnosed with sinus mucormycosis infection, which has emerged as one of the most fulminant, opportunistic secondary infection during post-COVID era. We report a case of a bilateral CRAO, in a 66-year-old, post-COVID, diabetic patient. A complete eye examination followed by radiological imaging of brain, orbit, and paranasal sinuses were done. Multidisciplinary approach was contemplated to reach a diagnosis of bilateral rhino-orbital-cerebral mucormycosis (ROCM). Intravenous liposomal amphotericin-B injection was started as a part of systemic management and an aggressive sinus debridement of both sides with amphotericin-B wash was also done. Despite an early diagnosis and intervention, the patient succumbed to her illness. All post-COVID patients presenting with the complaints of blurring of vision should be meticulously examined for the presence of any retinal abnormality in both the eyes as this may be a manifestation of an underlying secondary fungal infection. Early diagnosis of ROCM and management will help in reducing complications.

Delayed presentation of a congenital duodenal web managed successfully with incision of web.

One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.

Ventriculoperitoneal shunt induced neck mass mimicking sternocleidomastoid tumour: a previously unreported complication.

Ventriculoperitoneal shunt (VPS) for hydrocephalus is associated with various complications. Torticollis due to shunt tract fibrosis is a rare complication of VPS that occurs years later after the initial operation. However, shunt track fibrosis that progressed to large neck mass, mimicking sternocleidomastoid tumour and causing torticollis is a previously unreported complication. This led to the restriction of neck movement and hemifacial hypoplasia. Complete excision of the mass restored neck movement.