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.

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.

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.

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.

Medical applications of infrared thermography: A review.

Abnormal body temperature is a natural indicator of illness. Infrared thermography (IRT) is a fast, passive, non-contact and non-invasive alternative to conventional clinical thermometers for monitoring body temperature. Besides, IRT can also map body surface temperature remotely. Last five decades witnessed a steady increase in the utility of thermal imaging cameras to obtain correlations between the thermal physiology and skin temperature. IRT has been successfully used in diagnosis of breast cancer, diabetes neuropathy and peripheral vascular disorders. It has also been used to detect problems associated with gynecology, kidney transplantation, dermatology, heart, neonatal physiology, fever screening and brain imaging. With the advent of modern infrared cameras, data acquisition and processing techniques, it is now possible to have real time high resolution thermographic images, which is likely to surge further research in this field. The present efforts are focused on automatic analysis of temperature distribution of regions of interest and their statistical analysis for detection of abnormalities. This critical review focuses on advances in the area of medical IRT. The basics of IRT, essential theoretical background, the procedures adopted for various measurements and applications of IRT in various medical fields are discussed in this review. Besides background information is provided for beginners for better understanding of the subject.

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.

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.

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.

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.

Single-fiber grid for improved spatial resolution in distributed fiber optic sensor.

The spatial resolution of an optical-fiber-based Raman distributed temperature sensor is limited by the pulse width of the laser used. We discuss a methodology of increasing spatial resolution by using a single-fiber grid. Spatial resolution improvement of up to 10 times is demonstrated.

Nondestructive characterization of musical pillars of Mahamandapam of Vitthala Temple at Hampi, India.

This paper presents the first scientific investigation on the musical pillars of the Vitthala Temple at Hampi, India. The solid stone columns in these pillars produce audible sound, when struck with a finger. Systematic investigations on the acoustic characteristics of the musical pillars of mahamandapam (great stage) of the Vitthala Temple have been carried out. The 11 most popular pillars that produce sounds of specific musical instruments are considered for the investigations. The sound produced from these 11 most popular musical pillars was recorded systematically and different nondestructive testing techniques such as low frequency ultrasonic testing, impact echo testing, and in situ metallography were employed on the musical columns of these pillars. The peak frequencies in the amplitude spectrum of the sound produced from various columns in these pillars are correlated with the dimensional measurements and ultrasonic velocity determined using impact echo technique. The peak frequencies obtained experimentally have been found to have excellent correlation with the calculated flexural frequencies based on the dimensional measurements and ultrasonic velocities of the columns.

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.

Effect of digestion time and alkali addition rate on physical properties of magnetite nanoparticles.

We investigate the effect of digestion time and alkali addition rate on the size and magnetic properties of precipitated magnetite nanoparticles. It is observed that the time required to complete the growth process for magnetite nanocrystals is very short (approximately 300 s), compared to long digestion times (20-190 min) required for MnO and CdSe nanocrystals. The rapid growth of magnetite nanoparticles suggests that Oswald ripening is insignificant during the precipitation stage, due to the low solubility of the oxides and the domination of a solid-state reaction where high electron mobility between Fe2+ and Fe3+ ions drives a local cubic close-packed ordering. During the growth stage (0-300 s), the increase in the particle size is nominal (6.7-8.2 nm). The effect of alkali addition rate on particle size reveals that the nanocrystal size decreases with increasing alkali addition rate. The particle size decreases from 11 to 6.8 nm as the alkali addition rate is increased from 1 to 80 mL/s. During the size decrease, the lattice parameter decreases from 0.838 to 0.835 nm, which is attributed to an increase in the amount of Fe3+ atoms at the surface due to oxidation. As the alkali addition rate increases, the solution reaches supersaturation state rapidly leading to the formation of large number of initial nuclei at the nucleation stage, resulting in large number of particles with smaller size. When alkali addition rate is increased from 1 to 80 mL/s, the saturation magnetization of the particles decreases from 60 to 46 emu/g due to the reduced particle size.

Antioxidant activity of the oyster mushroom, Pleurotus ostreatus, on CCl(4)-induced liver injury in rats.

This study was undertaken to investigate the putative antioxidant activity of the oyster mushroom Pleurotus ostreatus on CCl(4)-induced liver damage in male Wistar rats. Intraperitoneal administration of CCl(4) (2ml/kg) to rats for 4 days resulted in significantly elevated (p<0.05) serum levels of glutamic oxaloacetic transaminase (SGOT), glutamic pyruvate transaminase (SGPT) and alkaline phosphatase (SALP) compared to controls. In the liver, significantly elevated levels (p<0.05) of malondialdehyde (MDA) and lowered levels (p<0.05) of reduced glutathione (GSH) were observed following CCl(4) administration. Quantitative and qualitative analysis of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (Gpx) revealed lower activities of these antioxidant enzymes in the liver of CCl(4)-administered rats. An analysis of the isozyme pattern of these enzymes revealed variations in relative concentration presumably due to hepatotoxicity. When rats with CCl(4)-induced hepatotoxicity were treated with the extract of P. ostreatus, the serum SGOT, SGPT and SALP levels reverted to near normal, while the hepatic concentration of GSH, CAT, SOD and Gpx were significantly increased (p<0.05) and that of MDA significantly (p<0.05) lowered, when compared to CCl(4)-exposed untreated rats. Histopathological studies confirmed the hepatoprotective effect conferred by the extract of P. ostreatus. These results suggest that an extract of P. ostreatus is able to significantly alleviate the hepatotoxicity induced by CCl(4) in the rat.