Relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients.

AIM: To determine the relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. METHODOLOGY: This prospective observational cohort study included 650 patients from 6 months to 18 years undergoing elective surgery at our institution. Elective surgery included procedures such as herniotomy, orchidopexy, urethroplasty, cystoscopy, PUV fulguration, pyeloplasty, ureteric reimplantation, stoma formation/closure, anorectoplasty, pull-through, choledochal cyst excision and repair, VP shunt insertion, lipomyelomeningocele repair, diastematomyelia excision and repair, and cyst excision. Nutritional status was standardized using Z scores for weight, length, and BMI. Patients were monitored for a month following surgery to detect any complications, and they were classified into five grades using the Clavien-Dindo classification. The duration of hospital stays and readmission within 30 days following discharge were secondary outcomes. RESULTS: There were 627 patients of both sexes involved in the study: 350 patients aged 6 months to 5 years (Group A), while 277 were aged between 5 and 18 years (Group B). Wasting status was 47.71% in Group A and 41.52% in Group B. In Group A, 40% of patients were stunted, while 83.75% were in Group B. Group A had 57.14% underweight patients. The complication rate was 39.14% in Group A and 38.99% in Group B. The incidence of postoperative complications was not significantly different in malnourished patients. The patients with prolonged duration of surgery (> 2 h) developed more complications in both groups (Group A-67.2%, Group B-82.6%; p < 0.0001). In addition, the patients who experienced complications had lengthier hospital stays (p < 0.001 in both groups) and increased readmission rates (p = 0.016 in Group A and p = 0.008 in Group B). CONCLUSION: In our study, half of the patients in Group A and nearly two-third in Group B were malnourished. The preoperative poor nutritional status based on anthropometric parameters is not associated with increased postoperative complications. Randomized control trials linking preoperative malnutrition based on anthropometric measures and clinical outcomes in pediatric surgery patients are necessary to provide more robust information on this subject.

Synergistic protective effect of picrorhiza with honey in acetaminophen induced hepatic injury.

Rhizome of picrorhiza along with honey prevents hepatic damage and cure the acetaminophen (paracetamol) induced hepatotoxicity by modulating the activity of hepatic enzymes. Here, we studied the in vivo effects of Picrorhiza kurroa and honey on acetaminophen induced hepatotoxicity Balb/c mice model. Hepatic histopathological observations of acetaminophen fed (day-6) group showed more congestion, hemorrhage, necrosis, distorted hepatic architecture and nuclear inclusion. Such damages were recompensed to normal by picrorhiza or honey alone or both in combinations. We observed increased activity of SGPT and SGOT in injured liver tissues, and that too was compensated to normal with picrorhiza or honey alone or both in combinations. We observed 1.27 and 1.23-fold enhanced activity of SGPT in serum and liver lysate, respectively while SGOT showed 1.66 and 1.11 fold enhanced activity. These two enzymes are signature enzymes of liver damage. Thus, our results support that honey may be used with drug picrorhiza due to its synergistic role to enhance hepatoprotective and hepatoregenerative ability along with allopathic drugs to mitigate the hepatotoxic effects.

Cross sectional study of osteoporosis among women.

Osteoporosis is a major public health problem, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden. The present study was carried out to screen the bone status (osteopenia and osteoporosis) above the age of 35 yrs in the women. A community based cross sectional study was carried out in 158 women by calculating WHO T-scores utilizing calcaneal QUS as diagnostic tool. The prevalence of osteoporosis and osteopenia was found to be 13.3% ± 5.29% and 48.1% ± 7.79% respectively. Statistical association of prevalence of osteopenia and osteoporosis was found to be significant with age group; gravida status; attainment of menopause; body weight and physically active status of the women. The statistical association was not significant in relation to the rank status of their husband, as well as dietary pattern of the women but still it has to be substantiated by conducting larger community based trials in future. The present study found that there was statistically significant relationship between age group and the prevalence of osteopenia and osteoporosis. There was a negative correlation between age of the women and BMD. Besides age, gravida status and menopausal status have negative correlation with BMD while positive correlation with physically active lifestyle. The results were found to be non-significant in relation to rank status of husband and dietary pattern.

Orthokeratinizing odontogenic cyst of maxilla with complex odontoma.

The orthokeratinized odontogenic cyst (OOC) and odontoma are the odontogenic cyst and tumor respectively that are minimally invasive neoplasms of head and neck region. OOC is a rare variant of odontogenic cyst characterized by the presence of excessive orthokeratin covering the cystic lining. Odontoma is a benign neoplasm/hamartoma often discovered accidently on panoramic radiographs. We came across a case of a 26-year-old male with swelling on his face along with difficulty in breathing. On the basis of radiographic and histopathological findings the final diagnosis of OOC associated with odontoma was given. However, there is no report in the English literature of the simultaneous occurrence of these two lesions and hence this case is very rare. It is unclear whether the two lesions were just coincidental or were actually related to each other.

Tooth agenesis: newer concept.

Developmental disturbances involving the oral cavity affect the growth and development of a child. Tooth agenesis may be associated with a number of documented syndromes or may present as an isolated entity. The presence or absence of teeth is decided by the influence of various genes and their signaling pathways. These syndromes appear due to chromosomal defects or due to mutations in the genes responsible for organogenesis. Identification of these mutations helps understand the underlying defect and plays an important role in their treatment strategies. This is a comprehensive review of literature on syndromic and nonsyndromic forms of dental agenesis and an attempt in enlisting various syndromes associated with dental agenesis.