Congenital Pouch Colon with Segmental Dilatation of Ileum: Congenital Pouch Colon Type 6.

Congenital pouch colon (CPC) is classified on the basis of anatomic morphology into five types. Congenital segmental intestinal dilatation associated with anorectal malformation (ARM) is very rare. We are adding two neonates of CPC type 2 associated with segmental dilatation of the ileum to single similar case described in the literature till date. Temporary stomas with excision of either of the pouches should be considered. "Defective mesenchyme formation during organogenesis" due to abnormal mesenchymal precursor cells is hypothesized as the cause for both ARM and different types of CPC.

Kluth Type IIIb6 Esophageal Atresia: Diagnostic Dilemma and Pitfalls of Using Infant Feeding Tube.

We describe three male neonates where infant feeding tube (IFT) passed 18-20 cm in the upper esophageal pouch. A blunt-tipped red rubber catheter confirmed esophageal atresia (EA) with long upper pouch in all three cases. Definitive management revealed EA with tracheoesophageal fistula and long overlapping upper esophageal pouch consistent with Kluth Type IIIb6 variant in two patients. Importance of using red rubber catheter at the pediatric practice instead of IFT is stressed.

Cloacal Malformation Variant in a Male Neonate.

Cloacal malformation is a rare entity and is invariably referred only to females. We are reporting a very rare case of cloacal malformation variant in a 6-day-old male neonate who presented with absent anal opening along with passage of urine and meconium from an abnormal opening in the perineum.

Kluth Type IV3 Membranous Esophageal Atresia at Middle One-third of Esophagus: An Extremely Rare Entity.

We herein present an extremely rare case of an isolated membranous atresia causing near-complete obstruction of the esophagus. The neonate presented with drooling of saliva and frothing from the mouth. A red rubber catheter met with an obstruction at 12 cm from the gum margins. Radiograph showed paucity of gas in the abdomen. Thoracotomy revealed external continuity of esophagus; dilated and elongated proximal segment constituting upper half of esophagus, and a membrane with tiny opening in the center, at its junction with narrow distal segment. Excision was performed. A high index of suspicion for membrane should be kept in dealing with esophageal obstruction beyond 10 cm from the gum margins, particularly those with paucity of abdominal gas pattern or gasless abdomen.

Two Stages Repair of Proximal Hypospadias: Review of 700 Cases.

OBJECTIVE: Surgical repair of hypospadias is challenging and problematic even for the most experienced specialists, and this is especially true when severe and complicated case is confronted. Many operations had been described for the management of this deformity. MATERIALS AND METHODS: During the period from May 2004 to December 2015, we performed 700 cases with proximal hypospadias, at our institute in the Department of Pediatric Surgery by a single surgeon. Data were collected retrospectively and included patient's age at operation, degree of the hypospadias, degree of associated chordee, complications, and cosmetic outcome. All patients underwent 2 two-stage procedures with 9-12 months interval in between. RESULTS: Seven hundred patients with proximal hypospadias were operated upon in a period of 11 years. Byars's 2 two-stage operation was used in all 700 cases. Neither complete disruption nor urethral diverticula occurred 2 two-stage procedures in the 700 patients. 677 (96.7%) patients had no complication. Fistula was present in 21 (3%) patients. There was no case of meatal stenosis in our study. CONCLUSION: Two stages procedure using the principles of Byar's technique is a versatile operation that can be used for 2 two-stage procedures the proximal hypospadias. It decreases the rate of fistula formation, disruption, and stenosis and gives a satisfactory cosmetic appearance.

Reusable nanobiocatalysts for the efficient extraction of pigments from orange peel.

Nagpur mandarin orange (Citrus reticulata) peels were subjected to treatment with nanobiocatalysts in the form of cellulase and pectinase immobilized magnetic nanoparticles (MNPs). MNPs (Fe3O4) with average diameter in range of 40-90 nm were immobilized with cellulase and pectinase through APTES and glutaraldehyde. Treatment followed by extraction into organic solvents resulted in 8-9 fold increase in extraction of carotenoidic pigments compared to use of free enzymes. Optimum pH and temperature for the process were determined to be 5.0 and 50 °C, respectively. The nanobiocatalysts could be reused across three cycles with only 15 % drop in yield per cycle. Dinitrosalicylic acid assays showed that superior peel hydrolysis also led to greatest extent of pigment extraction.

Nanomaterials for Agricultural and Ecological Defense Applications: Active Agents and Sensors.

The world we live in today is overpopulated with an unprecedented number of people competing for fewer and fewer precious resources. The struggle to efficiently steward and manage these resources is a global problem in need of concrete and urgent solutions. Nanomaterials have driven innovation in diverse industrial sectors including military, aviation, electronic, and medical among others. Nanoscale materials possess unique surfaces and exquisite opto-electronic properties that make them uniquely suited to environmental, biological, and ecological defense applications. A tremendous upsurge of research activity in these areas is evident from the exponential increase in publications worldwide. Here we review recent applications of nanomaterials toward soil health and management, abiotic and biotic stress management, plant defense, delivery of the RNA Interference (RNAi), plant growth, manufacture of agro-products, and ecological investigations related to farming. For example, nanomaterial constructs have been used to counter environmental stresses and in plant defense and disease diagnosis. Nanosensor chemistries have been developed to monitor water quality and measure specific pollutant levels. Specific nanomaterials such as silver, iron oxide, and zinc oxide proffer protection to plants from pathogens. This review describes progress in nanomaterial-based agricultural and ecological defense and seeks to identify factors that would enable their wider commercialization and deployment. This article is categorized under: Diagnostic Tools > Biosensing Toxicology and Regulatory Issues in Nanomedicine > Toxicology of Nanomaterials Diagnostic Tools > Diagnostic Nanodevices.

Outcomes of Fast-Track Multidisciplinary Care of Hip Fractures in Veterans: A Geriatric Hip Fracture Program Report.

BACKGROUND: Hip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India. METHODS: A total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year. RESULTS: The average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up. CONCLUSIONS: Elderly hip fracture has a high risk of mortality (14%-58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.

Surgical management of stage III pediatric empyema thoracis.

AIM AND OBJECTIVE: This study aims to report 100 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention, and follow-up. MATERIALS AND METHODS: All the children who underwent open decortication for stage III empyema thoracis during the study period January 2015-December 2016 were included. Preoperative workup included hemogram, serum protein, chest radiographs, and contrast-enhanced computed tomographic (CECT) scan of the chest. RESULTS: One hundred (65 males, 35 females) (age 2 months-13 years, mean 4.5 years) were operated during a 2-year period. Among them, 90% patients were referred 3 weeks after the onset of disease. Intercostal chest drainage (ICD) had been inserted in (95) 95% cases. Thickened pleura, multiloculated pus, and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in five patients. Decortication and removal of necrotic tissue were performed in all the patients. Mean duration of postoperative ICD was 4 days. Follow-up ranged from 1 month to 2 years (mean 12 months). There was no mortality. Five patients had proven tuberculosis. Only 10% presented within the early period of the disease. CONCLUSION: The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor.

Gallbladder Duplication Associated with Gastro-Intestinal Atresia.

Gallbladder duplication in association with other GIT anomalies is a rare entity. We report two neonates; one with duodenal atresia and the other newborn with pyloric atresia, ileal atresia and colonic atresia, both were associated with gallbladder duplication which has not been reported earlier.

Vesical calculi formation on the slit valves of a migrated distal end of ventriculoperitoneal shunt.

Various complications of distal end of the ventriculoperitoneal (VP) shunt have been described in the literature. We present, here, an extremely rare and potentially severe complication of vesical calculi formation on the slit valves of distal end of VP shunt which erosively migrated into the urinary bladder. Suprapubic cystolithotomy performed, peritoneal end of the tube found to be eroding and entering into the bladder with two calculi firmly stuck to slit valves in the distal end of the tubing were removed. Shunt was functional, therefore, it was pulled out and repositioned on the superior aspect of the liver; the urinary bladder was repaired. Patient did well postoperatively. This complication was revealed 1.5 years after the shunt was implanted. Although there were symptoms of dysuria and dribbling of urine of short duration, the patient did not show obvious peritoneal signs; suggesting that, penetration of a VP shunt into the urinary bladder can remain asymptomatic for a long period of time, disclosed late and can lead to considerable morbidity. Careful follow-up is important and management should be individualized.

Identification and modeling of a drug target for Clostridium perfringens SM101.

In the present study, comparative genome analysis between Clostridium perfringens and the human genome was carried out to identify genes that are essential for the pathogen's survival, and non-homologous to the genes of human host, that can be used as potential drug targets. The study resulted in the identification of 426 such genes. The number of these potential drug targets thus identified is significantly lower than the genome's protein coding capacity (2558 protein coding genes). The 426 genes of C. perfringens were further analyzed for overall similarities with the essential genes of 14 different bacterial species present in Database of Essential Genes (DEG). Our results show that there are only 5 essential genes of C. perfringens that exhibit similarity with 12 species of the 14 different bacterial species present in DEG database. Of these, 1 gene was similar in 12 species and 4 genes were similar in 11 species. Thus, the study opens a new avenue for the development of potential drugs against the highly pathogenic bacterium. Further, by selecting these essential genes of C. perfringens, which are common and essential for other pathogenic microbial species, a broad spectrum anti-microbial drug can be developed. As a case study, we have built a homology model of one of the potential drug targets, ABC transporter-ATP binding protein, which can be employed for in silico docking studies by suitable inhibitors.