Laparoscopic Management of Auto-Amputated Ovarian Cyst in an Infant.

ABSTRACT: The routine schedule of antenatal ultrasound scans has led to an increased frequency of detection of foetal ovarian cysts. Although most of them regress spontaneously, some may grow into large cysts and undergo torsion followed by auto-amputation. However, pre- and post-natal scans may fail to identify this event. We report a case of a prenatally diagnosed ovarian cyst that failed to resolve conservatively and was increasing in size in post-natal ultrasounds. Pre-operative ultrasound and magnetic resonance imaging failed to detect the auto-amputation. The diagnosis was confirmed on laparoscopy which offers a safe and effective method for the removal of ovarian cysts in neonates and infants.

Outcomes of Early Oral Feeding Compared to Delayed Feeding in Children after Elective Distal Bowel Anastomosis.

Background: Conventionally, oral feeds after distal bowel anastomosis surgery (ileostomy/colostomy closure) are delayed until after bowel peristalsis is established. The safety of an early feeding regimen is not established in children. This study compared early feeding regimens with delayed feeding in children undergoing elective intestinal anastomosis surgeries. Materials and Methods: In this retrospective multicentric cohort study, children undergoing elective distal bowel anastomosis surgery were divided into Group A (oral feeds allowed within 6 h) and Group B (delayed feeds). The two groups were compared for the incidence of abdomen distension, vomiting, surgical site infection, duration of analgesia, length of hospital stay, and readmission rate. Results: During the study, 58 patients were included: Group A (n = 26) and Group B (n = 32). The duration of analgesia (1.9 vs. 4.01 days) and length of hospital stay (3.38 vs. 5.0 days) were significantly less in Group A. Abdominal distension (7.7% vs. 15.6%), vomiting (11.5% vs. 15.6%), surgical site infection rate (3.8% vs. 12.5%), and readmissions (0% vs. 3.1%) were less in Group A, but statistically not significant. Conclusion: Early feeding after the elective restoration of distal bowel continuity can be safely practiced in the pediatric population. It is associated with a reduced need for analgesia and shorter hospital stay.

Nonhypertrophic Pyloric Stenosis in a Neonate: A Rare Presentation.

Gastric outlet obstruction in neonates due to nonhypertrophic pyloric stenosis (NHPS) is a rare cause. We report the case of a 37-day-old baby boy who presented with complaints of vomiting for the last 2 weeks and an inconsolable cry over the last 2 days. He has been vomiting seven to eight times a day, a few hours after breastfeeding. On ultrasonography, the stomach was distended, while the pylorus was not hypertrophied. An upper gastrointestinal (GI) contrast study was done, which was suggestive of gastric volvulus. We performed a laparoscopy for the same. Intraoperatively, the volvulus was already resolved. We performed gastropexy. Postoperatively, he had persistent symptoms, for which an upper GI endoscopy was performed. It demonstrated a narrow pylorus, consistent with the NHPS. We performed a laparoscopic Heineke-Mikulicz pyloroplasty. The patient's symptoms had improved postoperatively. He was discharged after 5 days.

Molecular Evaluation of Joubert Syndrome and Hearing Impairment in a Patient with Ataxic Cerebral Palsy.

Joubert syndrome (JBTS) is a rare autosomal recessive or X-linked congenital brain malformation with strong genetic heterogeneity. Other neurological features of JBTS include hypotonia, ataxia, developmental delay, and cognitive impairment. Hearing loss with JBTS has been reported in the literature. We present the case of a 3.5-year-old boy born to a healthy consanguineous South Indian couple who was presented with ataxic cerebral palsy (CP) and hearing impairment; medical reports confirmed typical brain malformations of JBTS. Hearing impairment was screened by audiological assessment, which confirmed the presence of severe-profound hearing loss with outer hair cell dysfunction. Whole-exome sequencing (WES) was performed to know the molecular aspects of the condition and to detect any novel mutations. The homozygous mutation AHI1 c.2023G > A associated with JBTS type 3 and GJB2 c.71G > A mutation associated with hearing impairment were identified. Sanger sequencing was performed to validate the result and it identified heterozygous AHI1 c.2023G > A and GJB2 c.71G > A in the patient's parents. This study confirms the diagnosis of JBTS by WES helps identify the genetic causes of hereditary disorders that accelerate genetic evaluation and counseling for at-risk families.

Acquisition of Pragmatic Skills in Paediatric Cochlear Implant Users.

Pragmatic language skills are one of the most complex language skills. Children with hearing loss face difficulty in social participation and effective communication during mainstreaming. Without mastery of these skills, children may encounter significant challenges with abstract conversational communication and literacy. This study aimed to explore the age and pattern of acquisition of pragmatic skills in hearing-impaired children. Twelve (12) children with Cochlear Implants (CI) in the age range of 5 to 10 years with minimum 1-year post-implantation regular therapy and twelve (12) age-matched normal hearing children participated in the study. All participants were administered the 'Test of Pragmatic Skills' (Shulman, 1986) comprising different domains of pragmatics. Their responses were rated on a six-point rating scale from 0 to 5. A qualitative analysis of various domains revealed that paediatric cochlear implant users used varied pragmatic skills at approximately 3 years on average during the post-implantation period compared to the typically developing children who acquired the skills well below 3 years on average. Pragmatics is very well correlated to the child's cognition; hence, the higher the cognitive age, the earlier the acquisition of pragmatic skills. The results prove that pragmatic skills developed proportionately to their implant age but need to be at par with their cognitive age. Rehabilitation of CI children, thus, should levy heavy focus on varied pragmatic domains, which will facilitate contextually appropriate communication at the earliest possible time during the post-implantation period.

Quality Improvement in Pediatric Surgical Ward Rounds after Implementation of Checklist.

Introduction: Using checklists has been common in high-risk industries such as aviation, space, and maritime sectors. It is routinely being used in health care also. Daily ward rounds play an essential role in patient care. Missing key details in rounds are common. Sometimes, these medical errors can lead to adverse events or mismanagement of patients. A checklist was introduced for daily ward rounds in our newly established institution. This study aims to assess the improvement in the documentation. Materials and Methods: A checklist for ward rounds was introduced in September 2018. During the study period, between July 2017 and January 2020, 30 random case records for each of the two groups were taken. Group A (without checklist) and Group B (checklist) were compared to see the documentation of patient identification, diagnosis, operative status, fresh complaints, vitals, examination findings, charting treatment, catheters/drains/intravenous access, and urinary status/bowel movements. Results: Sixty case records were included in the study. Comparison of documentation between Group A and Group B showed a significant difference in patient identification (50% vs. 100%), diagnosis (47% vs. 100%), operative status (33% vs. 100%), fresh complaints (76% vs. 100%), vitals (63% vs. 100%), examination findings (43% vs. 100%), charting treatment (73% vs. 100%), catheters/drains/intravenous access (10% vs. 86%), and urinary status/bowel movements (30% vs. 100%). Conclusion: Using checklists for daily ward rounds improves documentation. It reduces the gap in communication and potential errors in patient management.

Validation of Acoustic Breathiness Index (ABI) in the South Indian Population.

BACKGROUND: Acoustic Breathiness Index (ABI) is an acoustic model which equates to the auditory-perceptual (A-P) measure of breathiness. Globally, ABI has been validated in multiple languages. To date, empirical studies validating ABI in the South Indian population have not been carried out. Moreover, there is only minimal evidence on the impact of language and gender on ABI. OBJECTIVES: This study attempted to validate ABI in languages of Malayalam and Kannada with "B" and "G" of GRBAS. The authors also examined the influence of language and gender on ABI. METHODS: The authors retrospectively analyzed a dataset consisting of 160 voice samples (91 normophonic and 69 dysphonic). Five speech-language pathologists perceptually evaluated these samples on the GRBAS scale. PRAAT software was used to calculate ABI for each voice sample. The authors also determined the effects of language and gender on ABI. Following this, ABI's concurrent validity and diagnostic accuracy were examined relating to "B" and "G" of the GRBAS scale. RESULTS: The judges reached a moderate agreement on the perceptual evaluation of voice quality. The authors observed neither language nor gender differences in ABI. The concurrent validity of ABI was strong (r = 0.761) when correlated against "B". Further, evaluations revealed that an ABI value of >3.66 could distinguish between breathy and non-breathy voice samples with an area under the curve of 0.816 (Sensitivity = 61.73%; Specificity = 94.93%). On the other hand, the concurrent validity of ABI in correlation with "G" did not yield the optimal result. CONCLUSIONS: ABI is a valid acoustic tool for identifying breathiness in the languages of Malayalam and Kannada. ABI correlates better with "B" than "G" on the GRBAS scale. ABI is independent of language and gender.

Comparison and Validation of Acoustic Voice Quality Index Version 2 and Version 3 among South Indian Population.

BACKGROUND: Acoustic Voice Quality Index (AVQI) has emerged in the recent past as a robust multiparametric voice quality evaluation tool. Two versions of AVQI derived using the program PRAAT have found extensive clinical and research applications. These versions have been validated in several languages around the world. However, no research reports are available on validation of AVQI in the South Indian population. Further, studies comparing the performance of the two versions of AVQI are limited in the literature. OBJECTIVES: This study was designed to validate and compare the two versions of AVQI (AVQIv02.02 and AVQIv03.01) in South Indian languages (Malayalam and Kannada). METHODS: A retrospective analysis of previously recorded voice samples was carried out on a total of 160 (91 normophonic and 69 dysphonic) voice samples. These samples were perceptually rated on a GRBAS scale by five experienced speech-language pathologists. Standardized Syllable Number (SSN) necessary to derive AVQIv03.01 was computed. Following this, these samples were analyzed to obtain the AVQIv02.02 and AVQIv03.01. The concurrent validity and diagnostic accuracy of these measures were then examined and compared. RESULTS: A moderate agreement was obtained across the judges on perceptual evaluation of voice quality. SSN in Malayalam and Kannada languages were identified to be 29 and 25 syllables respectively. Language differences were not observed on both versions of AVQI. The concurrent validity of AVQIv03.01 (r = 0.788) was superior to that of AVQIv02.02 (r = 0.655). Further, the threshold of differentiating normophonic and dysphonic samples were determined to be >3.45 for AVQIv02.02 and >2.45 for AVQIv03.01. CONCLUSIONS: AVQIv03.01 is superior to AVQIv02.02 in terms of its diagnostic accuracy and concurrent validity. Current findings also extend the application of AVQI as a robust tool for the evaluation of voice characteristics to the South Indian population.

Visual impression of the colon over giant hydronephrosis in a child: A case report.

INTRODUCTION: Giant hydronephrosis is a rare manifestation of upper urinary tract obstruction. On clinical examination, a colonic band of resonance is appreciated on percussion due to presence of transverse colon anterior to the renal lump. However, visualizing the colon on inspection is not reported in the literature. PRESENTATION OF CASE: A 13-year-old girl presented with abdomen distension for a duration of two years. On clinical examination, the abdomen was grossly distended, with left side of abdomen more prominent. On inspection, the colonic impression was visualized. There was large cystic lump, above which, the colonic impression was observed. With percussion we could elicit the colonic band of resonance as well. Imaging and radionuclide scan revealed giant hydronephrosis of left kidney with poor function. Patient underwent a laparoscopic nephrectomy. Patient was discharged after 3 days. CONCLUSION: Giant hydronephrosis can present as gross abdomen distension. The presence of colon anterior to the renal lump can be appreciated by inspection during the clinical examination.

Effect of Age and Gender on Acoustic Voice Quality Index Across Lifespan: A Cross-sectional Study in Indian Population.

BACKGROUND: The human voice is dynamic and changes throughout the life span. The effects of age and gender on acoustical measures of voice quality have been well established. Assessment of voice quality using multiparametric measures has been recommended over singleton measures. Acoustic Voice Quality Index (AVQI), which is a multiparametric measure of voice quality, has gained popularity in the recent past. Studies investigating the effect of age on AVQI are very limited especially across the life span. The majority of the studies involving AVQI have been carried out in the European and East Asian populations. There is a dearth of studies involving AVQI in the Indian population. OBJECTIVES: The present study was taken up to investigate the effects of age, gender on the AVQI version 02.02 in the Indian population. The present study also aimed to establish reference data for AVQI in the Indian population. METHOD: AVQI and its constituent parameters were obtained from a total of 200 participants (50 pediatrics, 100 adults and 50 older adults) with an equal number of males and females. Multivariate Analysis of Variance was carried out to check the significant differences across age group and gender for AVQI and its constituent parameters along with interaction effects. RESULTS: AVQI values obtained from the Indian population were slightly higher than those reported in the earlier literature for the European and East Asian populations. AVQI obtained by pediatric and older adult groups was found to be significantly higher when compared to that of adults. Significant age effects were also demonstrated by AVQI. The values of AVQI were found to be more stable in adults than in pediatric and older adult groups. AVQI values did not differ significantly across older adult and pediatric groups. Gender effects were not observed in AVQI. CONCLUSION: This is the first study to report changes in AVQI across the lifespan in the Indian population. The present study adds on to the literature the reference measures of AVQI for the Indian population. Findings of the present study suggest that age can have an impact on AVQI v.02.02 values; even though it is independent of gender.

A Preliminary Exploration of Vocal Usage in Prospective Professional Voice Users (PPVUs): Students of the Alimah Course.

BACKGROUND: Students of the Alimah degree are Prospective Professional Voice Users whose career involves teaching, preaching, and conducting religious activities. For them, a cultured and efficient voice is an important prerequisite for a successful career. This study aimed to explore vocal usage and knowledge of voice care among students pursuing the Alimah course. OBJECTIVES: To check the period prevalence of voice problems among the students during the Alimah course, understand communication, and voice usage in daily situations, understand their lifestyle, assess their knowledge about voice and voice care through a self-reporting questionnaire. METHOD: The data were obtained from 150 undergraduate students pursuing the Alimah degree in and around Nagapattinam and Thanjavur districts of Tamil Nadu, India, through a self-reporting questionnaire. RESULTS: The students pursuing the course were at a high risk for developing voice problems, with a period prevalence of 70%. Excessive vocal load, inappropriate diet, phonotraumatic behaviours and limited knowledge of voice care were found to be the threats to voice problems among the population. CONCLUSION: This population with a high prevalence rate of voice problems should be studied further. The authors suggest including lessons on vocal enhancement methods and voice care in the course curriculum of the Alimah degree.

An Unusual Case of Choledochal Cyst.

Choledochal cyst (CC) is an important surgical cause of jaundice in infants. Infantile variant of CC can mimic biliary atresia in clinical presentation. CC associated with biliary atresia is well described in literature. We encountered an atretic variant of CC that has not been described in literature ever. The characteristics of this unusual case, management, and proposed hypothesis to its pathogenesis are discussed here.

Mapping of elasticity and damping in an α + ß titanium alloy through atomic force acoustic microscopy.

The distribution of elastic stiffness and damping of individual phases in an α + ß titanium alloy (Ti-6Al-4V) measured by using atomic force acoustic microscopy (AFAM) is reported in the present study. The real and imaginary parts of the contact stiffness k (*) are obtained from the contact-resonance spectra and by using these two quantities, the maps of local elastic stiffness and the damping factor are derived. The evaluation of the data is based on the mass distribution of the cantilever with damped flexural modes. The cantilever dynamics model considering damping, which was proposed recently, has been used for mapping of indentation modulus and damping of different phases in a metallic structural material. The study indicated that in a Ti-6Al-4V alloy the metastable ß phase has the minimum modulus and the maximum damping followed by α'- and α-phases. Volume fractions of the individual phases were determined by using a commercial material property evaluation software and were validated by using X-ray diffraction (XRD) and electron back-scatter diffraction (EBSD) studies on one of the heat-treated samples. The volume fractions of the phases and the modulus measured through AFAM are used to derive average modulus of the bulk sample which is correlated with the bulk elastic properties obtained by ultrasonic velocity measurements. The average modulus of the specimens estimated by AFAM technique is found to be within 5% of that obtained by ultrasonic velocity measurements. The effect of heat treatments on the ultrasonic attenuation in the bulk sample could also be understood based on the damping measurements on individual phases using AFAM.

Ensemble Empirical Mode Decomposition based methodology for ultrasonic testing of coarse grain austenitic stainless steels.

A signal processing methodology is proposed in this paper for effective reconstruction of ultrasonic signals in coarse grained high scattering austenitic stainless steel. The proposed methodology is comprised of the Ensemble Empirical Mode Decomposition (EEMD) processing of ultrasonic signals and application of signal minimisation algorithm on selected Intrinsic Mode Functions (IMFs) obtained by EEMD. The methodology is applied to ultrasonic signals obtained from austenitic stainless steel specimens of different grain size, with and without defects. The influence of probe frequency and data length of a signal on EEMD decomposition is also investigated. For a particular sampling rate and probe frequency, the same range of IMFs can be used to reconstruct the ultrasonic signal, irrespective of the grain size in the range of 30-210 µm investigated in this study. This methodology is successfully employed for detection of defects in a 50mm thick coarse grain austenitic stainless steel specimens. Signal to noise ratio improvement of better than 15 dB is observed for the ultrasonic signal obtained from a 25 mm deep flat bottom hole in 200 µm grain size specimen. For ultrasonic signals obtained from defects at different depths, a minimum of 7 dB extra enhancement in SNR is achieved as compared to the sum of selected IMF approach. The application of minimisation algorithm with EEMD processed signal in the proposed methodology proves to be effective for adaptive signal reconstruction with improved signal to noise ratio. This methodology was further employed for successful imaging of defects in a B-scan.

An absolute method for determination of misalignment of an immersion ultrasonic transducer.

An absolute methodology has been developed for quantification of misalignment of an ultrasonic transducer using a corner-cube retroreflector. The amplitude based and the time of flight (TOF) based C-scans of the reflector are obtained for various misalignments of the transducer. At zero degree orientation of the transducer, the vertical positions of the maximum amplitude and the minimum TOF in the C-scan coincide. At any other orientation of the transducer with the horizontal plane, there is a vertical shift in the position of the maximum amplitude with respect to the minimum TOF. The position of the minimum (TOF) remains the same irrespective of the orientation of the transducer and hence is used as a reference for any misalignment of the transducer. With the measurement of the vertical shift and the horizontal distance between the transducer and the vertex of the reflector, the misalignment of the transducer is quantified. Based on the methodology developed in the present study, retroreflectors are placed in the Indian 500MWe Prototype Fast Breeder Reactor for assessment of the orientation of the ultrasonic transducer prior to the under-sodium ultrasonic scanning for detection of any protrusion of the subassemblies.