Flap Closure in Neonatal Neural Tube Defects: Challenges in Flap Design and Lessons Learnt.

Background: Management of neural tube defects (NTDs) is challenging and the outcome is demanding. Aims: To analyze the outcomes in operated cases of NTDs closed using various types of flaps. Materials and Methods: The data between June 2017 and May 2023 were analyzed. The mode of presentation, timing of intervention, type of flap, neurological status after closure, status of the wound, presence of hydrocephalous, flap blackening, flap necrosis, features of sepsis, and the outcome were recorded and analyzed. Covered NTD; closure done using primary closure or 'Z' Plasty (everywhere); incomplete data; lost to follow-up; and not giving consent were excluded from the study. Results: Out of 92 cases, 35 were operated using the rhomboid flap, 33 using dufourmentel modification of limberg flap, and 24 using keystone island flap. The mean age at presentation was 4 days (range: 0-28 days). The mean duration of surgery after presentation was 2 days (range: 1-3 days). Mean operating time was 1.15 h (range: 0.45-3.15 h). A ventriculoperitoneal shunt was required in 62 cases at various stages. The preoperative and the postoperative power were nearly the same in all. Wound infection was seen in 2, 3, and 1 cases in each group. Blackening of the flap was seen in 3, 2, and 1 cases in three groups. Cerebrospinal fluid (CSF) leak was seen in 2, 2, and 0 cases. Wound dehiscence was present in one case in each group and sepsis was present in 2, 3, and 2, respectively. Conclusion: The management of open NTD requires adequate planning. CSF shunting and flap closure are often required.

New Framework for Understanding Cross-Brain Coherence in Functional Near-Infrared Spectroscopy (fNIRS) Hyperscanning Studies.

Despite the growing body of functional near-infrared spectroscopy (fNIRS) hyperscanning studies, the assessment of coupling between two neural signals using wavelet transform coherence (WTC) seems to ignore the directionality of the interaction. The field is currently lacking a framework that allows researchers to determine whether a high coherence value obtained using a WTC function reflects in-phase synchronization (i.e., neural activation is seen in both members of the dyad at the same time), lagged synchronization (i.e., neural activation is seen in one member of the dyad prior to the other member), or anti-phase synchronization (i.e., neural activation is increased in one member of the dyad and decreased in the other). To address this need, a complementary and more sensitive approach for analyzing the phase coherence of two neural signals is proposed in this work. The toolbox allows investigators to estimate the coupling directionality by classifying the phase angle values obtained using traditional WTC into in-phase synchronization, lagged synchronization, and anti-phase synchronization. The toolbox also allows researchers to assess how the dynamics of interactions develop and change throughout the task. Using this novel WTC approach and the toolbox will advance our understanding of complex social interactions through their uses in fNIRS hyperscanning studies.

Camouflage Detection and Its Association with Cognitive Style: A Functional Connectivity Study.

Background: Individual differences exist in performance in tasks that require visual search, such as camouflage detection (CD). Field dependence/independence (FD/I), as assessed using the Group Embedded Figures Test (GEFT), is an extensively studied dimension of cognitive style that classifies participants based on their visual perceptual styles. Materials and Methods: In the present study, we utilized fMRI on 46 healthy participants to investigate the underlying neural mechanisms specific to the cognitive styles of FD/FI while performing a CD task using both activation magnitude and an exploratory functional connectivity (FC) analysis. Group differences between high and low performers on the two extremes of the accuracy continuum of GEFT were studied. Results: No statistically significant group differences were observed using whole-brain voxel-wise comparison. However, the exploratory FC analysis revealed an enhanced communication between various regions subserving the cognitive traits required for visual search by FI participants over and above their FD counterparts. Conclusion: These enhanced connectivities suggest additional recruitment of cognitive functions to provide computational support that might facilitate superior performance in CD task by the participants who display a field-independent cognitive style.

Glans Anthropometry for Preputial Reconstruction in Hypospadias.

Background: Cases of hypospadias present for poor stream or cosmetic appearance. The main aim is to provide a visibly normal phallus. Preputial reconstruction is technical. A properly planned reconstruction based on anthropometry may improve the result. We are presenting our experience of reconstruction based on glans anthropometry. Aim: The aim of the study was to evaluate the importance of glans anthropometry in preputial reconstruction in cases of hypospadias. Materials and Methods: All cases of hypospadias operated between June 2014 and March 2022 were included. Glans width was measured at the base. The marking sutures for preputial reconstruction were taken at distance thrice the glans width at base. Those requiring religious circumcision along with repair, associated significant chordee, catheter came out before 2 weeks, or history of any previous penile surgery were excluded. All the cases were subjected to urethroplasty, meatoplasty, and preputioplasty. The results obtained were analyzed. Results: One hundred and forty-eight out of 159 cases formed the study group. There were 31 glanular, 42 distal penile, 58 mid-penile, and 17 proximal penile hypospadias. Mean glans width at base was 16 mm (range: 11-21 mm). Mean distance of marking suture at prepuce was 38 mm (range: 33-63 mm). Mean follow-up was 12 months (range: 1-36 months). Mean age at presentation was 23 months (range: 14-72 months). Mean operating time was 50 min (range: 45-60 min). Fistula at the base of preputioplasty was seen in four. Dehiscence of preputioplasty was seen in six. Meatal stenosis was seen in three cases. Conclusion: Preputial reconstruction improves the cosmetic appearance of the hypospadiac penis. Reconstruction based on glans anthropometry improves the result and avoids complications.

A rare case report of pseudo-pregnancy in a menopausal female.

Pseudo-pregnancy is an uncommon psychiatric presentation, often having a complex interplay of psycho-social factors making it difficult to manage. It is common to present in the reproductive age range, rarely in postmenopausal women. We are reporting a rare presentation of a 48-year post-menopausal widowed HIV-positive female with no live issues having two years of secondary amenorrhea complaining to have documented weight gain and experience of perceiving fetal movements for the past 5 months. However, she persistently insisted on antenatal care despite repeated reports of ultra-sonographic pelvis imaging and gynecological examination pointed toward menopausal changes and the absence of any live issue. This case report emphasizes the clinical presentation and management strategies for patients with pseudocyesis, a peculiar and rare psychiatric manifestation.

When I move, you move: Associations between automatic and person-coded measures of infant-mother synchrony during free-play using virtual in-home data collection.

The relationship between movement synchrony and global scores of behavioral synchrony were investigated during a naturalistic free-play between 33 infants (ages 12- to 24-months) and their mothers using a video-conferencing platform. We assessed movement synchrony by applying an automatic tool, motion-energy analysis (MEA), to the obtained video data. Dyadic movement synchrony was associated with higher levels of maternal sensitivity, infant involvement, dyadic reciprocity, and a child-led interaction pattern. This demonstrates the feasibility of using MEA as an automatic tool for assessing movement synchrony in mother-infant dyads and its application for investigating naturalistic at-home free play sessions in a remote setting.

Virtual social interactions during the COVID-19 pandemic: the effect of interpersonal motor synchrony on social interactions in the virtual space.

Although the link between motor synchrony and emotional alignment has been extensively studied during face-to-face interaction, the question of whether this association also exists in virtual settings has remained unanswered. Here, we examined whether this link exists during virtual social interactions and whether pro-social effects will be induced during those interactions. To this end, two strangers shared difficulties they have experienced due to the COVID-19 pandemic during a virtual social interaction that included both audio and video. The findings revealed that motor synchrony and emotional alignment can arise spontaneously during a virtual social interaction between two strangers. Moreover, this interaction yielded a decrease in negative affect and an increase in positive affect, as well as an increase in feelings of trust, liking, cohesion, self-other overlap, and similarity between the strangers. Finally, a higher level of synchrony during the virtual interaction was specifically associated with increased positive emotional alignment and liking. It can thus be presumed that virtual social interactions may share similar characteristics and social effects as face-to-face interactions. Considering the tremendous changes the COVID-19 pandemic has caused regarding social communication, these findings may provide grounds for developing new intervention protocols aimed at dealing with the consequences of social distancing.

Role of Various DW MRI and DCE MRI Parameters as Predictors of Malignancy in Solid Pulmonary Lesions.

PURPOSE: We aimed to evaluate various diffusion and dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) parameters in differentiating malignant from benign pulmonary lesions. METHODS: We enrolled 31 (22 males) patients who had solid pulmonary lesion(s) >2 cm in our cross sectional study. Of these, 23 (74.2%) were found to be malignant on histopathology. Dynamic contrast-enhanced MRI was performed using 36 dynamic measurements (volumetric interpolated breath-hold examination). Diffusion-weighted MRI (DW MRI) performed at b value of 800 s/mm2. We measured different diffusion and perfusion parameters, for example, diffusion-weighted imaging (DWI) SI, mean apparent diffusion coefficient (ADC), minimum ADC, lesion-to-spinal cord ratio, DWI score, T2 score, Ktrans, Kep, and Ve. We stratified values of each parameter as high if it was >median of values observed in our data set and low if it was ≤median. Normally distributed data were compared by unpaired t test, whereas non-normal continuous data were compared by Kruskal Wallis-H test. We applied Wilson score method to calculate sensitivity, specificity, and predictive values of parameters that were statistically significant by type of lesion with reference to histopathological examination as gold standard. RESULTS: Diffusion-weighted imaging SI, mean ADC, minimum ADC, DWI score and Ktrans values were found to be significantly different (P value < .05) by type of lesion. Ktrans was found to have the highest diagnostic accuracy (74.2%) among these parameters. CONCLUSION: Ktrans and mean ADC had similar sensitivity of 65.2%. However, Ktrans had highest diagnostic accuracy among various DWI and DCE MRI parameters in predicting malignancy in solid pulmonary lesions. In our study, we found a cutoff value 0.251 min-1 for Ktrans as 100% specific.

Predictability of 48-h delayed retention of contrast in barium enema in cases of chronic constipation.

INTRODUCTION: Diagnosis of Hirschsprung's disease depends on rectal biopsy. This study was designed to find an alternate diagnostic modality to exclude Hirschsprung's disease. AIM: The aim of this study was to find the predictive value of delayed retention of contrast in excluding Hirschsprung's disease. MATERIALS AND METHODS: All cases of chronic constipation presenting during the study duration from June 2014 to June 2016 were included. Those without any obvious history of conservative management were excluded. Parameters considered in barium enema were initial film, routine films, and delayed retention of contrast at 24, 48, and 72 h. They were then subjected to rectal biopsy. The results of rectal biopsy and barium enema were analyzed. RESULTS: One hundred and thirty-eight patients presented during the study duration. One hundred and twenty-eight formed the study group. The average age of presentation was 48 months (range, 1-144). The average duration of prior medical management was 8 months (range, 6-48 months). Forty-two cases were diagnosed as Hirschsprung's disease on rectal biopsy. The symptoms resolved in 31 cases after rectal biopsy and 42 cases after definitive surgery. In the remaining 55 cases, dietary modification along with laxatives was instituted, and they were kept under follow-up. The average follow-up was 12 months (range, 6-48 months). Of the various parameters in barium enema, delayed retention of contrast at 48 h had the highest negative predictive value of 99.67%. CONCLUSION: Delayed retention of contrast at 48 h has the highest negative predictive value in excluding Hirschsprung's disease. This can safely be used to exclude Hirschsprung's disease in cases of chronic constipation.

Transanastomotic tube in intestinal atresia: How beneficial are they?

INTRODUCTION: Intestinal atresia requires multiple surgeries and long hospital stay. We tried managing these cases by primary anastomosis with transanastomotic tube (TAT) for early feeding. AIMS: The aim of the study was to analyse the outcomes in patients of intestinal atresia who underwent primary anastomosis with a TAT. MATERIALS AND METHODS: The records between June 2014 and November 2017 were analysed. Those with incomplete data or unclear final outcome were excluded. Patients managed by primary anastomosis with TAT (Group A) or without TAT (Group B) were included. The TAT was kept for 6 weeks. Oral feeds were started after 2 weeks in all the cases. P < 0.05 was considered as statistically significant. RESULTS: Forty-eight cases were included. There were two duodenal atresia, 29 jejunal atresia and 17 ileal atresia. The mean age at surgery was 2 days (range: 1-16 days). There were 42 cases in Group A (with TAT) and six in Group B (without TAT). The average duration of start of feeds was 78 h (range: 72-96 h) in Group A and 402 h (range: 360-504 h) in Group B (P = 0.01). The mean duration of hospital stay was 7 days (range: 5-15 days) and 27 days (range: 19-48 days) in Group A and B, respectively (P = 0.02). The overall survival was 38 (91%) and 3 (50%) in Group A and B, respectively (P = 0.01). Reexploration was required in 2/42 and 2/6 cases in Group A and B, respectively (P = 0.4). Total parental nutrition was required in 2/42 and all cases in Group A and B, respectively. CONCLUSION: Primary repair in intestinal atresia with a TAT is a practical option. The overall outcome is better.

Variability in proteinase-antiproteinase balance, nutritional status, and quality of life in stable chronic obstructive pulmonary disease due to tobacco and nontobacco etiology.

CONTEXT: Although the role of proteinase/antiproteinase imbalance in chronic obstructive pulmonary disease (COPD) due to tobacco is well established, information in COPD due to nontobacco etiology is sparse. AIMS: To assess the variability in metalloproteinase activity in COPD related to tobacco and nontobacco causes. SETTINGS AND DESIGN: This is a hospital-based, prospective, observational study. SUBJECTS AND METHODS: Serum matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were estimated in 200 subjects divided equally into four groups, i.e. COPD in tobacco smokers, COPD in nonsmokers but with exposure to biomass-related indoor air pollution, smokers without COPD, and nonsmoking healthy controls. Anthropometric skinfold measurements, quality of life (QOL) using St. George Respiratory Questionnaire, and exercise capacity using the 6-min walk test (6-MWT) were carried out. Groups were compared using analysis of variance and Kruskal-Wallis plus Mann-Whitney U-test to assess differences between groups. The Chi-square and Fisher's exact tests were used to evaluate associations among categorical variables. Spearman's rank correlation was calculated to assess the correlation between data. RESULTS: Patients with COPD due to either tobacco or nontobacco etiology were older, more malnourished, had worse QOL, and poorer exercise capacity compared to non-COPD subjects. Triceps, subscapular, and suprailiac skinfold thicknesses were less in smokers with COPD than biomass-related COPD. MMP-9 and TIMP-1 levels were similar across all groups. TIMP-1 significantly correlated with 6-MWT among all groups. CONCLUSIONS: The protease-antiprotease balance in COPD is similar irrespective of the presence or absence of tobacco exposure but is related to poor exercise capacity.

Correlation of radiological investigations with clinical findings in cases of abdominal mass in the paediatric age group.

BACKGROUND: The aim of the following study is to find out the accuracy of clinical examination and radiological investigations in determining the organ of origin and diagnosis in cases of abdominal mass. PATIENTS AND METHODS: This prospective study included patients presenting with a palpable abdominal mass. Complete detailed history and clinical examination were done prior to any investigation to find out the possible clinical diagnosis and determine the organ of origin. Radiological investigations were done by blinded senior radiologist to form a radiological diagnosis and determine the organ of origin. Final diagnosis was used to see the accuracy of both the pre-operative modalities. RESULTS: There were 50 cases which formed the study group. Male to female ratio was 2:1. Prepubescent age was the most common age group at presentation. Right hypochondrium was the most commonly affected quadrant (18%). Most of these masses were hepatobiliary in origin. The overall accuracy of ultrasound with respect to the final diagnosis was 45/50 (90%). Ultrasonography findings correlated with a clinical diagnosis in 91% of those who were operated and in 88% in those confirmed by biopsy or other modalities. Radiological investigations in total had accuracy of 94%, which was similar to the clinical examination. Both radiological diagnosis and clinical diagnosis were correct in 47/50 (94%) cases. CONCLUSIONS: Most of the cases of abdominal mass can be well evaluated clinically in terms of the diagnosis and organ of origin. Both radiological investigation and a good clinical examination have equal sensitivity. Radiological investigations are thus only adjuvant to a good clinical examination.

Radioprotection of Swiss albino mice by Myristica fragrans houtt.

Nutmeg, the dried seed kernel of Myristica fragrans, MF (Family: Myristicaceae) possesses antifungal, hepatoprotective and antioxidant properties. Its radioprotective effect against 6, 8 and 10 Gy gamma radiation was evaluated by 30 day survival assay. Regression analysis yielded LD(50/30 )as 6.83 Gy and 8.89 Gy for irradiated only and (MF + radiation) groups, respectively. The dose reduction factor was computed as 1.3. Administration of MF significantly enhanced hepatic glutathione (GSH) and decreased testicular lipid peroxidation (LPO) level whereas acid phosphatase (ACP) and alkaline phosphatase (ALP) activity did not show any significant alteration. Irradiation resulted in significant elevation in LPO level and ACP activity, and decreased the GSH content and ALP activity. MF pretreatment effectively protected against radiation induced biochemical alteration as reflected by a decrease in LPO level and ACP activity, and an increase in GSH and ALP activity. The present study has implications for the potential use of MF as a radioprotector.